/ 


L  1  B  RA  R,Y 

OF  THE 

UNIVERSITY 

or    ILLINOIS 


?. 


llUMfllS  IWSTORJCAl'SURm 


\'  S    "-i!;. 


ILLINOIS  HISTORICAL  SURVEY 


The  Rise  and  Fall 
of  Disease 


in 


Illinois 


IN  TWO  PARTS 


Printed  b)  authorily  of  the  Slate  of  lllinoii 


LIBRARY 

UWIVERSiiy  OF  ILLINOIS 

UREANA 


The  Rise  and  Fall 


of 

Disease  in  Illinois 

by 

ISAAC  D.   KAWLINGS,  M.  S.,  M.  D. 

in  collaboration  with 

WILLIAM  A.  EVANS.  M.  D.,  D.  P.  H.. 
GOTTFRIED  KOEHLER.  M.  D..  and 
BAXTER  K.    RICHARDSON.  A.  B. 


PUBLISHED    BY 

THE    STATE    DEPARTMENT    OF    PUBLIC    HEALTH 

IN    COMMEMORATION    OF    ITS    FIFTIETH    ANNIVERSARY 

1927 


ILLISTRATEU    WITH    GRAPHS    DEVELOPED    AND    DRAWN 

BY  A.  F.  DAPPERT.  AND   WITH    PICTURE    REPRODUCTIONS 

OF  MANY  PERSONS  ASSOCIATED  IN  ONE  WAY 

OR  ANOTHER  WITH  THE  STORY. 


INDEXED  Br  CLARA   BREEN 


IN  TWO  PARTS 


^isJSgipaa- 


ScHNEPP  &  Barnes,  Printers 
Springfield,  III. 


PREFACE. 

rrcifound  changes  have  taken  place  during  the  last  one  hundred  years 
in  all  departments  of  civilization  but  in  none  has  the  transformation  been 
mure  fundamental  nor  more  nobly  crowned  with  advantage  than  in  the  field 
of  health.  At  the  beginning  of  this  period  man  was  little  short  of  a  helpless 
victim  to  infectious  diseases  that  frequently  swept  over  whole  cities  and 
nations  in  great  lethal  waves.  Today  he  is  able  to  exercise  a  marvelous  con- 
trol liver  the  factors  involved  in  health,  adding  strength  to  his  years  and 
years  to  his  life. 

The  need  for  genuine  jirogress  in  the  conquest  against  disease  was 
essential  to  the  healthy  contiiuiity  of  human  life  amid  the  growing  complexity 
of  modern  existence.  Swifter  means  of  communication  have  brought  all 
men  closer  together  for  good  or  for  evil.  Disease  respects  neither  wealth 
nor  social  rank,  becoming  a  universal  hazard  when  the  human  carrier  of 
infection  mav  he  thrust  across  a  continent  between  the  rising  and  setting  of 
the  sun.  When  automotive  ])ower  unites  a  nation  into  one  great  social  and 
commercial  commingling,  obliterating  political  boundary  lines  and  increas- 
ing enormously  the  range  of  individual  contact  between  fellow  beings,  there 
can  be  no  compromise  with  comnumicable  disease.  When  days  have  been 
reduced  to  hours  and  hours  to  minutes  in  measuring  the  travel  distance  be- 
tween points  man  has  no  choice  but  to  conquer  or  succumb  to  the  agents  of 
epidemic  infections.  That  he  has  subdued  one  after  another  of  these  ancient 
enemies  is  a  signal  manifestation  of  man's  superiority  over  all  living  things 
and  a  splendid  evidence  that  humanity  is  sweeping  onward  toward  that  great 
millenium  which  has  lived  in  the  aspirations  of  men  since  the  beginning  of 
time. 

The  story  of  how  man  has  triumphed  over  disease  in  Illinois  ought  there- 

~~'"  fore  to  be  of  common  interest  to  every  person  in  the  State.     Life  is  as  dear 
..to  the  beggar  on  the  street  as  il  is  to  the  lord  in  the  mansion,     b'actors  that 

?";  tend  to  preserve  or  destroy-  health  in  the  one  operate  toward  like  ends  in  the 
'  other.     Both  may  rejoice  in  the  advancements  of  medical  and  sanitary  science 

J^^  which  have  made  possible  the  remarkable  improvement  in  health  conditions 

that  are  described  in  this  volume.     Both  have  inherited  a  score  of  \ears  from 

1  the  wisdom   that   led   sanitarians  and   doctors   to   apply   their   knowledge    for 

.^-tke  public  good. 

1  hat  the  State  created,  dexelujied  and  maintains  an  official  agency 
charged  with  the  duty  and  responsibility  of  participating  in  a  moxeiuent  so 
pregnant  with  jiossibilities  for  individual  and  public  benefit  ought  to  stim- 
ulate jjride  and  confidence  in  the  character  ol  our  government. 

•■^:) 


It  is  the  dut\'  nf  Stale  officers  in  rt-cord  the  ini]Hii-tant  features  of  the 
public  health  inovenieiit  as  has  been  (Imie  in  tliis  vdiunie.  It  is  the  ])rivilege 
of  inchviduals  to  read  and  study  these  records,  iioth  processes  will  prove 
helpful  in  guiding  future  activities  to  even  greater  triumphs  than  the  ])ast  has 
witnessed  over  the  enemies  of  human  health. 

Lex  Sm.\ll. 


FOREWORD. 

The  title  of  this  vohiiiie  expresses  a  very  gratifying  actuaHty  with 
greater  approximation  to  the  whole  truth  than  might  he  surmised  at  first 
tihish.  It  may  not  be  universally  known  that  since  the  coming  of  white  men 
into  Illinois  a  considerable  number  of  diseases  have  been  kindled,  flamed  into 
constiming  plagues  and  were  then  extinguished  altogether  or  have  left  only 
the  dying  embers  of  what  may  soon  be  transformed  into  the  ashes  of  history. 
Cholera,  malaria,  smallpox,  yellow  fever,  typhoid  fever,  dysentery  and  per- 
haps diphtheria  may  be  included  in  that  group.  Tuberculosis,  the  diarrheal 
infections  and  scarlet  fever  were  once  far  more  deadly  and  widespread  than 
they  are  now. 

These  and  other  diseases  were  not  introdticed  into  Illinois  in  keeping 
with  some  predestined  program  prescribed  by  fate  to  pursue  the  particular 
group  of  people  who  elected  to  make  the  prairies  their  home.  On  the  con- 
trary they  came  when  conditions  created  by  man  himself  invited,  and  they 
began  to  disappear  when  conditions  created  by  man  began  to  be  intolerable 
for  them.  Most  of  the  conditions  which  invited  disease  were  in  that  respect 
created  unconsciouslv.  Xearl\-  all  of  the  factors  which  have  influenced  the 
waning  strength  of  infections  were  consciously  and  deliberately  employed  to 
improve  health  conditions. 

Thus  we  have  two  very  definite  periods  in  the  health  history  of  Illinois. 
One  embraces  the  time  when  communicable  diseases  played  havoc  with  the 
public,  finding  nothing  to  check  them  in  their  gruesome  business  but  the 
natural  limitations  of  time,  space  and  susceptible  material.  The  other  in- 
cludes the  years  since  the  public  first  began  to  employ  scientific  metlmds  of 
prevention  which  h;ive  played  havoc  with  disease. 

.Accordingly  \.h\>  volume  is  divided  into  two  parts.  The  first  relates  ihe 
story  of  health  conditions  from  the  very  earliest  times,  so  far  as  records  per- 
mit, down  to  187 T  when  the  State  began  its  attack  ujion  disease  with  the 
organization  of  the  State  Board  of  Health.  The  second  relates  to  the  fifty 
year  period  between  18TT  and  1927,  during  which  time  a  strong  pulilic  health 
service  developed  with  telling  results. 

There  was  no  purpose  to  make  this  an  exhaustive  accoimt  of  all  the 
factors  involved  in  the  field  of  health  improvement.  Such  an  ambitious  un- 
dertaking would  lead  into  the  paths  of  medicine,  bacteriology,  chemistry, 
agriculture,  economics,  engineering,  etc.  .\n  effort  has  been  made  to  trace 
the  history  of  communicable  diseases  in  broad  outline  and  to  describe  the 
origin  and  develo])nient  of  organizations  devoted  entirely  or  in  some  sig- 
nificant and  direct   way  to  the  promotion  of  ])ublic  health.      Il   is  believed 

CM 


10  KOKI!\VORI) 

that  some  reference  may  be  found  in  this  vcjUiiiu-  to  all  important  events  bear- 
inji  upon  the  subject  t)f  ])ublic  liealth  in  ihc  State,  thus  bringing  together  in 
one  ])lacL'  many  valuabU-  recnrds  that  were  widely  scattered  before. 

It  was  the  original  plan  tn  include  cha|)tcrs  relating  to  the  organization 
and  develo])ment  of  municipal  lioards  and  departments  of  hc'alth  in  the  State. 
This  scheme  was  abandoned  at  the  last  moment,  after  account  had  been 
written  (if  e\ents  in  sexeral  cities  and  muiu'  had  been  put  into  t\pr.  hicause 
cif  limited  time  and  s|iace.  The  hojie  tmw  is  that  another  vohnne  will  fol- 
low thi>  one.  pro\iding  s]iace  {(U'  a  fuller  story  about  local  public  health 
work  than  this  \dhtme  could  ever  have  accommodated. 

Aside  from  the  collaborating  authors  much  credit  for  liringing  this  ma- 
terial together  is  due  to  Miss  Clara  Breen,  wdiose  untiring  efforts  in  searching 
records,  collecting  photographs  and  cross  checking  source  liiaterial  and  to 
Miss  Elin  Berg  whose  services  in  classifying  the  source  material  and  man- 
aging the  stenographic  work  have  made  the  task  easier.  Credit  is  also  due 
to  the  chiefs  of  the  various  divisions  of  the  State  Department  of  Public 
llcalth  who  furnished  the  records  embraced  in  the  account  of  the  divisions 
and  to  1  )r.  Carl  lUack  of  Jacksonville  who  very  generously  supjjlied  the  jjlates 
of  several  photographs  that  would  otherwise  have  been  difficult  to  secure. 

The  Editor. 


CONTENTS. 

Pakt  One. 

PAGE 

Preface  by  Governor  Small 7 

Foreword    U 

Introduction    13 

General   1  lealth  History   Prior  to   18" 15 

The  Indian    15 

The  French   Regime    '■^2 

The  British   Regime    2G 

The  Spanish   Influence   27 

The  American   Regime   27 

History  of  Certain  Diseases  Prior  to  187^ 35 

Cholera.  43  ;  Consum|.)tion,  (iO  ;  Cynanche,  55  ;  Diarrhoea  and  Dy- 
sentery, 83  ;  Diphtheria.  55  ;  Erysipelas,  50  ;  Gonorrhea,  (in  ; 
Malaria.  35;  Measles,  54;  Meningitis,  5() ;  Milk  Sickness,  >U'< ; 
Nursing  Sore  Mouth,  (iiJ ;  Ophthalmia-Epidemic,  57  ;  Pneumonia 
and  Influenza,  62 ;  Puerperal  Fever,  65 ;  Scarlet  Fever,  53 ; 
SmalljKix.  49 ;  Snake  P)ite,  47  ;  Syphilis,  58 ;  Tuberculosis.  60 ; 
Tyjihoid  I'^ever,  (ill ;  Typhus  Fever,  47  ;  Yellow  Fever,  46. 

Infant   Mortality    SG 

Deaths  of  L'hildren  Lender  Five 88 

Seasonal   Distriliuti(in  nf  Disease 8i) 

\"ital  Statistics  and  Mortality  from  All  Causes !)(i 

Health  in  ."some  Cities  Prior  to  1877 101 

Chicago    101 

Springfield    115 

Kaskaskia    1 1  (; 

Shawneetown    11 S 

X'andalia    118 

(11) 


12  con'thnts 

Part  Two. 

i'ac;e 
Public    llt-alth  Admiiiistraiidii 127 

Genesis  (if   Public   1  U'alili   1  .:i\v 127 

l^evel(i])iuciit  cif  Stale  1  IcaUli  Service i;i;? 

Stall'    Health    Machinerv l;ii; 

Rauch   Regime    1  'Mi 

Mgau   Regime    1 .")!) 

1  )rake    Keniiue    1 ;  4 

Rawlini;^   Regime   I'.ii 

lutra-De|)artnieutal  <  )r,i,fauizati(in    208 

luifnrcenient  of   Medical   Practice  Act 2T3 

Auxiliary    1  lealth   At^encies 2S7 

Mealth  C'onditious  After    is:: 304 

Cerebrospinal  Fever.  ;5:();  Cholera.  3'2() :  Diarrhoea!  Diseases,  3TT  ; 
Pneumonia.  3S:  ;   Polionivelitis,  380  ;' Scarlet  Fever,  348;  Small- 
])ox,   3o:  ;    Tuberculosis.   3(il;    Typhoid    Fever,    338;   Whooping 
(.out^h.  3!M);  \'ello\v  Fever.  3-^:  ;  Infant   Mortality.  393. 
Sitniniar\    and   Conclusion 39G 


INTRODUCTION. 

Acccirding  to  traditimi  the  first  dcciqiants  of  the  llliiKiis  terrii(ii\-  were 
the  mound  builders. 

They  were  followed  by  the  Indians.  W  hence  they  came  to  the  Illinois 
territor)-  is  a  matter  of  surmise. 

The  rather  acccjited  opinion  is  that  the  first  Indian  occupants  of  the 
territory  came  from  tiie  west.  Tribes  generally  accepted  as  being  of  west- 
ern origin  occu])ie(l  tjie  region  at  the  time  when  the  jiressure  of  white  men 
in  the  countr\-  to  the  westward  caused  a  migration  liringing  some  more  east- 
erly trilies  of  Indians  into  conflict  with  the  tribes  of  western  origin. 

At  the  time  white  men  began  coming  into  the  territory  the  conflict  be- 
tween the  eastern  and  western  tribes  had  not  ended.  To  the  south  of  Illi- 
nois there  lay  a  great  lumting  grovnid  which  served  as  a  barrier  against  the 
southern  Indians.  From  Pickett's  History  of  .Alabama  we  learn  that  one 
tribe  migrated  from  Mexico  north-eastward  to  the  Illinois  territory  but  they 
did  not  remain  long.  Thev  soon  moved  southward  across  Kentucky  and 
Tennessee,  to  come  to  rest  in  .\labama,  and  tiie\'  never  ventured  north  again. 

If  the  Indians  of  the  south  had  malaria  and  (jther  fevers  the\'  had  little 
oii])ortunit\-  to  spread  them  in  Illinois.  If  there  was  anv  transmission  of 
disease  from  one  Indian  tril)e  to  another  such  transfer  was  from  east  to 
west  or  west  to  east. 

The  first  French  and  French-Canadians  came  into  the  territory  in  llwO. 
From  KiTO  to  ITCi^l.  practicalK-  one  hundred  vears,  the  so-called  French 
period,  the  territory  was  occupied  liy  Indians  and  French  and  lialf  breeds 
in  varying  proportions. 

The  first  French  invaders  were  trapjiers.  These  were  soon  followed 
by  missionaries.  Next  came  the  traders  and  tinally  the  settlers.  There  was 
a  moderate  amount  of  inter-inarriage  between  the  French  and  the  Indians. 
Abj..i  of  tlic  half  ])reeds,  many  of  whom  remained  in  the  territory  after  the 
Indian>  left,  were  thi'  results  of  French  and  Indian  unions. 

Tlu-  sources  of  information  as  to  heaUh  concHtions  in  tlie  French  period 
;ire  few.  I'he  missionaries  wrote  voluminous  reports,  but  thev  dealt  with 
such  subjects  as  religion,  the  geography  of  the  countries,  the  routes  of  travel, 
the  .'iltitudc  of  the  Indians  with  almost  no  reference  to  healtli.  'Ihe  trap- 
pers did  not  write  at  all.  .V  few  of  the  traders  wrote  but  they  gave  scant 
space  to  health. 

In  ITG:!  the  l-'rench  ceded  the  territory'  to  the  ilritish  who  relaiued  sonic 
control  until  Claik  wrested  it  from  them  just  prior  to  \]S{).  in  the  British 
period  of  less  than  seventeen  years,  the  governing  nation  (bd  lillle  more  than 
occupy  the  garrisoned   forls   with   a    few   troops   and   piomote   intrigue   wilh 

(13) 


14  IXTKODI'CTIOX 

tlu-  liiiliaiis.  Tlu'  |)(i|iulali(Jii  (luring-  tlic  l-lrilish  in-iiiid  were  Indians,  I'Voncli 
and  niixfd  hrcrds,  a  few  American  settlers  and  a  few  British  settlers  and 
a  few  inMi|i,-..  'rin-  I'.ritish  did  not  mate  with  tlu-  Indians  as  the  French  fre- 
<Hicntly  did. 

A  small  Spanish  expediti<in  cmsscd  fmm  .Missnuri  tu  Saint  josuiiii, 
Michigan.  This  incident  was  too  hricf  and  inconsccjuential  to  be  designated 
as  a  Spanish  ])criod. 

In  KSO.  after  L'lark  had  ca|itnre<l  the  llritish  fort  in  the  sonlhern  end 
of  the  lerriiory  the  Americni  c(jlonists  began  to  settle  the  Stale  especially 
the  sonlhern  ]iart  thereof. 

The  Territorial  period  heginniug  in  l'.S4,  ran  until  the  State  was  taken 
inlii  the  I  'nion  in  181S. 

I'dr  the  purposes  of  this  histor\-  (jf  the  Slate  as  such,  ihe  _\ears  hetween 
ISKI  and  r.('.'^,  are  divided  into  two  ]>eriods.  I^^IS  to  ISTT.  hfty  nine  years, 
the  perio<l  of  invasion  and  spread  of  disease,  and  1877 — the  year  of  the  or- 
ganization of  the  State  Board  of  Health  to  l!i"27 — fifty  years— the  period 
of  the  control  of  disease. 

The  first  srctioii  of  the  book  shows  how  the  settlers  and  their  descend- 
ants suffered  from  the  hardships  occasioned  by  disease.  To  combat  this  there 
was  no  state  health  department  .ind  no  local  health  de])artment  capable  of 
coping  with  situations,  except  in  t  liicago,  and  then  not  until  the  decade  of 
the   Civil    War, 

The  number  of  physicians  was  not  large  and  there  were  no  hospitals 
outside  the  cities. 

During  the  jieriod  a  few  diseases  declined  principally  because  the  land 
was  cleared  and  drained.  Others  becaiue  worse  liy  reason  of  the  increasing 
density  of  population. 

The  srcniid  section  deals  ])rincipally  with  the  development  of  the  State 
Department  of  Public  Health.  There  are  sections,  however,  which  deal  in  a 
more  fragmenlar\-  way,  with  some  of  the  extra-governmental  health  agencies. 

Since  the  State  l-)oar<l  of  Ilealth  licensed  physicians  and  regulated  the 
practice  of  medicine  between  Is7;  and  1!II7,  the  control  of  medical  practice 
is  given  some  attention. 

The  second  jieriod.  1S77  to  ]'J'i'i,  is  one  in  which  disease  has  been  grad- 
u.alK-  coming  under  control.  This  is  particularly  true  of  the  diseases  whicli 
pre\ail  especiallv  in  summer,  of  the  iliarrbeas  and  (Jysenteries  of  ailults, 
the  disorders  of  infancy  and  early  ciiildhood  and  particularly  of  the  digestive 
distiu'bances  of  babies,  the  contagious  and  infectious  diseases  and  a  few 
others.  The  programs  of  health  ilepailiuenls  fur  the  future  contem])late  control 
of  man\'  disorders  now  not  under  control,  or  even  under  lire,  as  well  as  the 
promotion  of  bodily  growth  and  \igor.  The  title,  "period  of  disease  control" 
does  not  exaclK  lit  the  facts  but  the  discrejjancies  are  not  of  major  importance. 


GENERAL  HEALTH  HISTORY  PRIOR  TO  1877. 
The  Mound  Builders. 

1'he  mound  builders  whoever  they  may  have  been  were  in  Illinois  before 
the  Indians.  The  State  abounds  in  mounds.  Even  in  that  day  there  seemed 
to  have  been  some  separateness  between  the  inhabitants  of  the  north  end  of 
the  State  and  those  of  the  south  end,  between  whom  there  lay  the  neutral 
largely  unoccupied  prairie  belt.  The  mounds  (if  the  north  are  of  a  ditt'erent 
type  of  construction  and  had  a  ditTerent  ])urpose.  While  there  are  some 
exceptions  the  rule  is  that  the  mounds  of  the  north  end  of  the  State  were 
ceremonial  structures  not  used  for  burying  or  for  utilitarian  purposes,  while 
most  of  those  of  the  south  end  of  the  State  were  used  for  the  latter  purposes. 

There  is  no  proof  that  the  moimd  builders  passed  on  any  diseases  to  the 
Indians  or  contributed  m  any  way  to  the  health  history  of  Illinois.  However. 
Zeuch'  suggests  that  the  mound  builders  were  wiped  out  by  pestilence.  If 
so.  the  disease  seems  to  have  destroyed  itself  in  destroving  its  host.  .-\n 
allusion  to  syphilis  and  the  mound  liuilders  will  lie  found  in  the  section  de- 
voted to  syphilis. 

The  Indians. 

The  opinion  of  the  times  is  that  the  Indians  came  from  .Asia  arri\ing 
on  the  northwest  coast  and  gradually  spreading  southward  and  eastward. 
In  their  slow  march  across  latitudes  and  longitudes,  across  climates  and  up 
and  down  elevations  they  acquired  habits  and  customs,  religious  observances 
and  diseases,  disorders,  health  and  ill  health,  strength  and  weaknesses  that 
were  more  or  less  peculiar  to  them. 

The  Indians  remained  in  Illinois  for  a  centm-y  and  a  half  after  the 
white  man  invaded  the  .^tate.  They  had  their  own  villages  and  the\-  did  not 
often  remain  long  in  the  white  man's  towns.  The  rule  was  that  these  \illages 
were  moved  with  great  frequency  though  for  manv  \ears  there  might  lie  a 
village  at  a  given  location  at  some  time  during  a  part  of  each  \ear.  .Sfldom 
did  a  village  remain  constantly  in  one  location. 

.S(ime  white  men  lived  among  the  Indians  as  captives  and  some  as  s{|uaw 
men.  They  were  responsible  for  large  numbers  of  half  breeds.  The 
captives  and  S(|ua\\   men  frequentl\-  returned  to  live  with  the  white  men.  but 

'  Zeucli    (lli.'^t.iry    of    .M.-di.-al    Practice    in   llHnoi.s,   vol.    1,   I'.iL'T.      T.ucius   H.    Zeuch). 
(15) 


IC)  (Jli.NEK.M.    lli;.\I.ril    11IST0R\'    TRIOR   TO    \S',', 

tlu-ir  Indian  \vi\-c's  and  thi'ir  mixed  hrct-d  projjenv  did  not  ahvaj's  follow 
them  in  this  mnvc.  W'lu'n  the  Indians  mo\'c'(l  dul  nf  the  State  thev  tucik  with 
them  most  of  these  half  hreeds. 

Dnring  the  more  than  one  hnndred  years  of  ccmtaei  in  the  district  nn- 
questionahly  the  Indian  in  some  measure  modified  the  health  of  the  white 
man  and  the  white  man  modified  that  of  the  Indian  hut  the  influence  was 
sur]irisinsjly  small. 

The  Indian  constitution  was  the  result  of  many  influences.  Because  of 
his  lack  of  thrift,  foresight  and  energy  he  was  subjected  to  periodic  lean 
years.  In  consequence  of  liis  life  lie  had  a  cajiacity  for  great  and  sustained 
effort  and  an  abilit_\'  to  withstand  hunger.  He  had  a  fine  stature  on  the 
average  and  great  physical  vigor.  To  those  diseases  which  threatened  him 
in  the  wild  state  he  had  a  fine  resistance  and  yet  he  was  short  lived.  He  died 
at  an  average  early  age  and  there  were  few  children  in  the  average  Indian 
family.  It  is  not  easy  to  understand  why  so  fine  a  constitution  went  hand 
in  h.ind  with  a  short  life  span  and  small  families  with  children  spaced  far 
■d]>:in.  History  would  indicate  that  wars  and  famines  furnished  the  expla- 
nalion. 

The  historv  of  Indian  medicine  contributes  little  to  the  answer.  To 
l)e.i,'in  with  the  Indians  had  n<i  literature,  medical  or  other.  They  had  a  very 
elaborate  medical  machinery,  but  it  was  largely  religious  and  ])olitical  and 
it  was  medical  in  little  more  than  name.  Thuugh  medical  in  name,  it  was 
magic  in  fact,     l^ven  that  part  called  medical  was  princi|jally  magic. 

l>e\ond  a  slight  knowdedge  of  medical  plants  and  medicinal  waters  the 
Indian  medicine  men  had  no  medical  knnwledge.  They  knew  almost  no 
ianitarv  science.  The  tribe  knew  enougli  to  move  a  camp  when  the  soil 
became  badly  fouled  but  there  is  nothing  to  show  that  the  medicine  men 
knew  any  more  about  this  than  the  others  did. 

As  to  sanilarv  science  in  general  the  Indians  never  knew  a  tithe  of  what 
th;'  Jews  did  in  the  lime  iif  Moses. 

Though  the\-  had  ikj  books  and  no  written  history,  they  did  have  legends 
of  outstanding  occurrences.  Had  there  been  great  epidemic  disease  waves 
among  ibem  some  tradition  of  these  nnist  have  survived.  It  is  altogether 
possible  that  the  scanty  ])opulation,  the  short  life  and  the  small  family  were 
qualities  for  which  war,  and  famines  were  ])rinci|ially  responsible. 

This  e.\j)lanation  does  not  undermine  our  regard  for  the  Indian  consti- 
tulion.  but   the  matter  is  of  small  consequence  since  the    Indians  removed 


GENERAL    HEALTH    HISTORY    ruinu 


1S7' 


l: 


from  the   State  leaving  behind  as  progenitors  of    future  citizens  not   very 
nianv  mixed  breeds  and  still  fewer  straight  bloods. 

Hrdlicka-  says.  "The  traditions  of  the  In- 
dians, the  existence  among  them  of  elaborate 
liealing  rites  of  undoubtedly  ancient  origin, 
their  plant  lore  in  which  curative  agent's  prop- 
erties are  attributed  to  many  vegetaljle  suli- 
stances  and  the  presence  among  them  of  a 
innnerous  class  (if  professed  healers,  honored, 
feared,  and  usually  well  paid  would  seem  to 
indicate  that  diseases  were  not  rare,  but  actual 
knowledge  and  even  tradition  as  to  their  na- 
ture are  wanting.  The  condition  of  the  skele- 
tal remains,  the  testimony  of  early  observers 
,ind  the  present  state  of  some  of  the  tribes  in 
this  regard  warrant  the  conclusion  t'nat  on  the 
whole  the  Indian  race  was  a  comparatively 
healthy  one.  It  was  probably  spared  at  least 
Some  of  the  epidemics  and  diseases  of  the  old  world  such  as  smallpox, 
rachitis,  while  other  scotu-ges  such  as  tulierculosis,  syjihilis  (pre-Columbian) 
tvphus,  cholera,  scarlet  fever,  cancer  etc..  were  rare  if  occurring  at  all." 

It  would  be  difficult  to  ini|jrove  on  this  statement.  It  was  written  Ijy  a 
man  who  know,  well  the  literature  on  Indian  health  written  prior  to  his  day 
and  wild  has  had  years  of  opportunity  to  study  the  jiroblem  at  first  hand. 
It  is  in  general  accord  with  all  references  found  in  the  literature.  The  state- 
ments he  make■^  are  a  skeleton  on  which  some  further  comment  can  be  hung. 
While  the  majoritv  of  Indians  lived  in  villages,  these  villages  were 
changed  at  rather  short  intervals. 

Black  Hawk  spoke  of  ;i  village  on  the  Rock  Ri\er  which  his  tribe  was 
occupying  in  1816,  saying  (.)f  it  that  it  was  in  a  good  location  and  had  an 
abundant  pure  water  sup])ly.  "Our  village  was  healthy",  he  said.  The  point 
he  was  making  was  that  they  had  a  village  there  for  fourteen  years  ;  there- 
fore, they  wanted  to  be  regarded  as  having  ownershi])  and  being  fixtures  in 
the  Rock  River  X'alley.  But  even  at  that  the  population  periodically  moved 
in  and  out  of  the  village  returning  to  it  for  some  part  of  the  time  in  each 
year  of  the  fourteeiL  The  Illinois  Indians  did  not  have  organized  commun- 
ity government  and  town  stability  as  it  was  known  among  such  southern 
Indians  as  the  (hickasaws  and  Mobilians. 

This  type  of  Indian  village  or  cani]i  had  no  organized  excreta  dis])osal, 
the  nearliy  cover  speedily  became  befouled,  whereupon  the  Indians  moved 
their  camp  to  a  clean  terrain. 


■  HrcUicka    (Bur 


!>luB> 


It    1.   p. 


Ales  HriUicka). 


li-i  (;i-:nki;ai.  iii-.ai.tii  iiistokv  tkiiik   tcj   |sT7 

.Mcxaiukr  Ros.s-'  has  a  diffeicnt  explanation,  lie  .say.s,  "But  anolhcr 
cause  and  perhaps  the  best  that  can  be  assigned  for  their  abandoning  their 
winlcr  doiniciles  as  soon  as  the  warm  weather  sets  in  is  the  immense  swarms 
of  rit'as  thai  bri'rd  in  them  during  that  season.'' 

If  there  was  such  a  disease  as  typhoid  fever  in  that  day.  there  is  no  evi- 
dence thai  the  Indians  had  ii.  The  sparseness  of  tine  population  (and  there 
were  hut  fi'w  Indians)  the  ci'stom  of  frequent  renioval  of  their  villages  to 
new  and  clean  locations  wimld  have  been  sonn-  protection  against  typhoid 
fever  had  theri'  been  such  a  disease.  llnllick,-i  writer  that  even  toda\'  t\i)hoid 
is  ver\'  rare  among  Indians. 

The  Indians  had  [ilenly  of  diarrhocal  troubles.  .M(.)st  of  the  writers 
sjieak  of  digestive  difficulties  probal]l\  including  in  the  term  indigestion  due 
to  poor  food,  constipation  and  diarrhoea  and  dysenter}-.  Some  go  into  more 
details.  Koss  wrote  in  ISKi  as  follows:  "The  diseases  most  fre(juent 
among  these  Indians  are  indigestion,  fluxes,  asthma,  and  consumption.  In- 
stances of  longevity  are  found,  liut  not  often.  Babies  suckle  their  mothers 
until  they  are  old  enough  to  feed  themselves  (on  the  Indian  diet).  The  in- 
fant is  generally  robust  and  healthy  but  the  mother  soon  becomes  an  old 
woman."  .Mexander  Henry  (  KiKt-Kii-l)  said  "The  Indians  were  in  general 
free  from  disorders  and  an  instance  of  their  being  subject  to  dropsy,  gout  or 
stciie  never  came  within  ni\  knowdedge.  Inilanniiations  of  the  lungs  are 
among  the  most  prevalent  disorders." 

Father  i\lar(|uette  died  from  a  chronic  d\senterv  which  had  manv  of 
the  earmarks  of  amoebic  dysentery.  It  is  difficult  to  see  how  his  disorder 
could  have  been  other  th,-m  th.it. 

In  Parkman's  account  of  .Marcpiette's  illness  and  death  it  is  stated  that 
on  one  nn'ssion  he  went  far  down  the  Mississippi  (as  far  as  the  Arkansas) 
an<l  that  somewhere  on  that  trip  he  contracted  dysentery.  He  and  his  party 
turned  northward  traveling  up  the  j\lississi]ipi  ;ind  Illinois.  Somewdiere  in 
the  Chicago  area  he  became  too  weak  to  travel.  His  companions  left 
him  in  ;i  cabin  and  went  back  to  Canada,  b'tuher  Marquette  lived  in  the 
vicinity  for  al)out  three  years  after  he  got  dysentery,  becoming  better  and 
almost  well  at  limes,  but  always  relapsing.  He  was  alile  to  travel  consider- 
ably during  this  jieriod  in  the  territory  of  Illinois  and  uji  on  the  Wisconsin 
River  and  to  Green  Bay.  I-'inally  he  had  a  relajise,  Iiecame  verv  ill  and  h;id 
hemorrhages.  Realizing  that  his  end  was  near  he  started  anrand  the  foot 
of  Lake  Michigan  and  the  .Michigan  shore,  dying  enroute.  If  this  was  a  case 
of  amoebic  dysentery  it  would  be  diflicult  to  think  that  he  did  not  infect  some 
Indians  during  these  )-cars  of  illness. 

=  P.nss  r.ArlvonOire.s  of  the  Fir.st  Settlers  on  the  Oieprim  or  Columbia  River,  edited 
with  historical  iiitroduelion  and  notes  by  Mile  Milton  (.iuait'e.  .  .  .  t'hieago,  R.  R.  Don- 
nelley &  Sons  Conipanv,  192.'!.      Alexander  Ross). 


GENERAL   HEALTH    HISTORY   PRIOR  TO    187?  19 

That  the  infant  mortality  rate  among  Indians  was  not  exterminating^  is 
explained  bv  their  custom  of  keeping  the  baby  at  the  breast  until  it  was  well 
over  one  year  of  age  and  often  for  months  or  even  years  longer.  This  cus- 
tom, however,  was  in  part  rc^jjonsiljlc  for  their  comparatively  low  birth  rate 
and  their  stationary  populalicm.  An  Indian  woman  bore  and  reared  few 
children  as  compared  with  the  while  woman  of  the  day.  The  children  came 
far  apart. 

It  is  altogether  jirobable  that  the  Indian  did  not  have  any  form  of  ma- 
larial fever  to  an  extreme  degree.  There  were  m()S(|uitoes  but  they  were 
not  infected. 

,\lexan<ler  Henry  writing  of  IMO-lltJf  said  "MMS(|uitiie^  and  a  minute 
species  of  lilack  fly  aljounded  on  this  river.  Sickness  was  unkiKiwn."  In 
three  places  in  his  reports  Henry  refers  to  clouds  of  mosquitoes,  but  the 
mosquitoes  ciiuld  not  have  been  infected.  There  is  no  report  of  malaria  or 
fevers  and  here  is  the  statement  frt)m  Henry  that  sickness  was  unknown 
coupled  closelv  with  his  report  on  the  abundance  of  mosquitoes. 

The  Indians  lived  along  the  streams  and  yet  the  writers  do  not  refer  to 
any  disease  which  could  be  malaria.  Contrast  their  rejiorts  with  ihnse  of 
malaria  among  the  colonial  settlers  who  in  later  years  followed  the  Indian 
custom  of  settling  along  the  rivers  and  in  the  bottoms.  It  appears  that  even 
today  the  Indians  are  fairly  immune  to  malaria. 

Hrdlicka  says  that  aiiKJUg  the  "^'umas  malaria  is  the  must  prevalent  dis- 
ease. That  the  (  )i>atas  and  Tarahumares  have  much  malaria.  A.  B.  Hol- 
der wrote  in  is'.i".":  "In  the  Indian  territory  and  among  a  few  trilies  else- 
where malaria  l)ecomes  of  greater  importance  than  consumiition." 

I'lUt  such  reports  were  not  made  until  the  Indian  had  been  long  in  con- 
tact with  the  white  man.  How  much  disease  did  the  Indians  contriliute  to 
the  early  history  of  the  State?  To  what  diseases  were  they  suliject?  What 
did  they  pass  on  to  the  whites?  let  us  answer  the  question  as  to  a  few 
diseases. 

Consitmpfioii. 

Hrdlicka  says  if  consumption  existed  at  all  among  prehistoric  Indians 
it  was  extremely  rare.  It  was  seldom  seen  up  to  a  ci'iUury  ago.  It  is  grad- 
ually becoming  more  common.  \Mien  he  wrote  this  he  was  reporting  on 
the  Indians  of  the  southwest  (  l!H),s),  but  he  knows  the  Indians  elsewhere 
and  their  history  as  well  as  any  man.  He  also  wrote,  ".\mong  the  uncivi- 
lized tribes  pneumonia  is  the  worst  hu''g  infection,  but  among  the  civilized 
tribes  consumi)tion  begins  to  rival  it." 

However,  Drake  wrote  in  ISI:!,  "The  mosi  prevalent  disease  of  the  In- 
dians is  scrofula.      It  almost  annihilated  the  I'eorias."      V,\  scrofula  he  meant 


'New   York   Mi-dii-al   Record,   Any.    !.■!,   is;i2 


20  GKXKUAL    HEALTH    IlISTOUY    PRIOK  TO    1S7? 

liiherculosis  of  the  glands,  hmu-s  and  lnn,<;s.  At  the  time  he  referred  to,  the 
I'eorias  were  at  least  ai)])r(iaehinL;  the  cla>s  whicli  ITrdlicka  calls  the  civilized 
trilies.  It  is  also  to  he  rcineinliereil  that  the  Indians  had  heen  in  con- 
tact with  whites  since  soon  after  the  year  UidI).  Dr.  Esmond  R.  Long  is 
my  authoiit\-  fur  the  statement  that  the  J 'nritan  fathers  sufl'ered  heavily 
from  coii>tiniiiiiiin  the  lirsi  year>  ihe_\-  >])ent  in  America.  They  niay  have 
infected  >ome  Indian^  wlm  later  carried  infection  westward.  It  i^  not  proh- 
ahle  that  the  Indians  ni  the  early  days  in  Illinois  gave  the  white  man  much 
consnniptioii. 

Piiriinniiild. 

^\w\\  lecnrds  as  are  availahle.  indicate  that  the  Indians  had  a  great  deal 
of  inieunKiiia  and  pleurisy,  llrdlicka  referring  to  the  Indians  of  the  south- 
west twentv  years  ago  says:  "I'neumonia  has  appeared  in  epidemic  form." 
'Hiis  disease  was  epidemic  rather  freiitu-ntly  among  the  white  settlers  in 
Illinois.  If  anything  saved  the  Indians  from  similar  epidemics  it  was  the 
s[iarseness  of  the  population,  the  >mall  size  uf  the  villages  and  the  open  air 
living. 

Ditinliixd  (iinl  Di/si'iifrni. 

That  digestive  disorders  including  diarrhdcas  and  dysenteries  were  ])rev- 
alent  among  the  Illinois  Indiana  i?.  certain  from  the  records.  Ne.xt  to  the 
rheumatic  di.-orders  the  diarrhoeas  and  dysenteries  are  mo>t  frei|ueinly  al- 
]ud.-,l  to. 

A iHdihic  Difsi  iiti  1)1. 

l''ather  .\lan|uette  contracted  what  ajipears  to  have  been  amoebic  dysen- 
tery while  goiug  down  the  Mississippi  associating  all  the  time  with  the  In- 
dians. Ill'  then  returned  to  the  Illinois  territory  where  he  remained  an  in- 
fectious i-ase  or  infective  carrier  all  of  the  time  until  his  death. 

Tllllhni,!. 

llrdlicka  savs.  "Contrary  t(j  all  expectations  typhoid  is  rare."  The 
essav  bv  Louis  which  established  ty])hiiid  as  a  separate  disease  was  not  writ- 
ten until  eight  \ears  before  the  Indian-,  were  moved  from  Illinois.  It  was 
not  generallv  known  in  Illinois  until  after  the  Indians  had  gone,  but  the  prob- 
abilitv  is  that  typhoid  \va>  not  prevalent  among  the  Illinois  Indians.  They  did 
not  seem  verv  --u-^ceptible  to  fevers  of  any  sort. 

MdldiKl. 

.Malaria  i^  thdUgbt  U<  li.ive  pretty  will  wi|)ed  tint  the  Nez  Perces.  It  is 
\er\-  prevalent  among  some  trd)e>  in  the  southwest,  but  the  writings  do  not 
show  that    Illinois    Indians  suH'ered  heavily    from  it   if  at  all. 


GENERAL   HEALTH    HISTORY   TRIOR  TO    1877  21 

VoiiTcal  Disca,sc. 

^o  far  as  cuiicenis  venereal  disease  in  general  the  Indians  seem  lo  have 
snlYered  far  more  from  the  white  man  than  the  white  man  did  from  the  In- 
dians. X'enereal  disease  was  said  lo  j)revail  anmng  the  drinking,  degraded 
[ncHans  who  camped  near  while  men's  towns,  hut  not  among  Indians  who 
kepi  away  therefrom.  Tile  Irihal  reguhitions  were  aimed  at  protection  of 
the  Indians  against  venereal  disease  among  the  whites.  Their  attitude  in- 
dicated their  fixed  conviction  that  the  white  man  was  the  source  of  the  vener- 
eal infections  of  every  kind  that  the  Indian  found  among  his  people. 

Jiecause  of  the  interest  in  the  discussion  of  pre-Columbian  s_\phili-  a 
separate  heading  is  given  to  the  history  of  svphilis  of  the  Indians. 

Blicillliilfisill. 

It  is  certain  that  rheumatism  troubled  the  Indians  greatly.  It  is  im- 
possible to  say  where  they  got  it,  who  brought  it  to  them,  if  anybody,  where 
it  originated  or  came  from.  The  Indians  seem  to  have  recognized  that 
ex])(isure  played  a  part  in  causing  it.  They  also  seem  to  have  recognized 
the  \alue  of  hot  baths  in  curing  it.  Most  of  the  hot  s])rings  enjoying  wide 
vogue  today  were  handed  (jver  to  the  white  man  from  the  Indians  as  health 
resorts  particular! \  in  rheumatic  disorders.  Wandering  a  little  afield,  the 
fact  that  the  Indians  ai)preciated  the  value  of  .Sulphur  Springs  in  skin  dis- 
orders is  some  ]jroof  that  they  suiTered  from  parasitic  skin  disorders. 

Rheumatism  is  known  to  have  existed  among  the  l\gvptians  as  proven 
by  the  lesions  in  mummies.  .\lso  among  the  cave  dwellers  of  France  and 
.Sp.nin  king  liefore  the  Egyptian  period.  In  fact  the  skeletons  of  wild  ani- 
als  found  in  caves  in  Europe  jjrove  the  j)re\alence  of  rheumatism  among 
animals  in  prehistoric  times.  This  is  s<ime  indication  that  the  Indians  had 
rheumatism  before  the  white  man  came. 

Schoolcraft  (llistoiw  of  the  Indian  Tribes  of  the  United  States  ]S51 
and  IS.')!)  publishes  a  letter  on  the  Indians  written  by  Dr.  T.  S.  William- 
son of  (  )hio,  after  this  phvsician  had  lived  among  the  Dacotas  iov  many 
vears.  The  hulian  withers  at  the  touch  of  civilization  but  not  because  of 
fevers  or  other  sickness.  Dr.  Williamson  said:  "The)-  know  nothing  about 
the  proper  treatment  of  fevers."  There  is  no  reason  to  think  they  had  had 
much  ex])erience  with  malaria  or  typhoid.  "The  summer  of  ISliT  is  rettdered 
memorable  in  Indian  history  b\-  the  ravages  of  smallpo.x."  ( )ne  reason  as- 
signed for  the  deadlv  character  of  this  disease  among  Indians  was  ihat  it 
was  realK'  a  fever  and  the  Indian.s  knew  nothing  ;ibout  the  treatnu-nt  of 
fevers.  The\-  were  more  experienced  in  treating  diarrhoeas  and  diseases  call- 
ing for  jnirgation  and  rheumatic  disorders. 

I  le  said,  "Dacota  females  are  far  less  subject  to  wdiat  are  termed  "female 
disorders'."      Miscarriage  was  infrequent.     The  infreqtiency  of  female  com- 


22  ciCNickAi.  III;. \i. Ill   iiisr(iK\    rkidk  m   l.sTT 

plaints  anil  iui>carria,L;cs  wdiild  >cciii  lu  indicate  that  ihc  Indians  did  not 
sutTer  nuu-li  I'mni  xcntTcal  (li>casr,  cither  gonorrhea  or  sy])hiHs. 

'Idle  siatenieiit  liiat  "the  liuHan  witliers  at  the  tcuich  of  civilization"  sug- 
gests so  far  as  Illinois  is  concerned  thai  the  while  intruders  into  this  territory 
gave  nuich  disease  to  the  Indians  ihere  and  recei\ed  lnu  little  from  them. 

Schoolcraft  (History  of  the  Indian  Trihe^  (jf  the  United  States  185T) 
agrees  witli  the  opinion  that  tin-  Kjw  liinh  rate  nf  ilu-  Indians  was  the  reason 
tor  ilu'ir  lewne^s,  savins^-,  "It  i>  a  wfll  known  fact  thai  the  Indian  tribes  do 
not  increase  in  the  ratio  of  other  nations.  The  average  number  of  children 
to  each  family  does  not  exceed  two."  Other  contributing  causes  given  by 
Schoolcraft  were  laziness,  lack  of  thrift  and  ])rudence,  lack  of  will  or  even 
desire  to  ])o]iulate,  occupy  and  u.se  the  laml.  ,iiid  their  addiction  to  alcohol. 
In  his  \-i-ry  extensive  writings  on  the  subject  he  refers  to  no  disease  as  being 
very  hannfnl  to  the  Indians  in  a  racial  way.  except  smallpox.  This  disease 
did  at  tiin^s  almost  wipe  out  villages  and  even  tribes.  He  specifically  states 
thai  pe--iilence  was  of  minor  importance  as  compared  with  low  birth  rate 
and  alcohol  in  wiping  out  the   Indian  poinilations. 

Slim  iiinrji. 

Summing  it  all  up  it  appears  that  the  Indian  during  his  residence  in 
contact  with  white  men  in  the  Illinois  territory  from  the  incoming  of  the 
wliitc  man  about  IGIO  until  the  de]iarture  of  the  Indian  in  l!-i37,  contributed 
but  little  to  the  white  man's  diseases — scarcelv  more  than  he  contributed 
to  the  constitution  of  the  racial  stock,  composed  of  several  white  bloods 
and  a  \ery  small  infusion  of  Indian  blood. 

The  French  or  French-Canadian  Regime. 

TiiK  Fiii:.\(ii-( '.\x.\iii.\.\  TitAPrKiis,  ^Lis.^^ioxakies  .\xd  Tk.uiers. 

Soon  after  the  whites  came  to  America  they  began  to  find  their  way 
among  the  Indians.  Some  of  these  were  captives,  some  were  squaw  men 
and  some  lived  among  the  Indians  because  they  loved  the  life. 

llowcNcr,  these  were  of  little  significance  from  the  social  stand]>:>int. 
They  had  little  intfuence  in  the  methods  of  living  of  the  Indians,  nor  is  there 
any  evidence  that  they  altered  the  lieallli  problems  of  the  Indians  materially 
for  either  the  ln-tter  or  worse. 

On  the  otlier  hand,  the  fairly  definite  French-Canadian-  trapper-  trader- 
missionary  iiioNcmcnt  in  Illinois  was  of  social  significance.  It  altered  the 
religious  life  of  the  Indians  and  .also  their  habits  and  customs  in  some  degree. 
The  bio,grapliy  of  ( iurdon  .s.  Hubbard  contains  nianv  allusions  to  the  heavv 
drinking  of  the  ln<lians  and  considerable  fighting  occasioned  therel))-.  It 
is  interesting  lo  noti-  that  1  lubbard  gives  an  account  of  the  shooting  of  Alexis 


GENERAL  HEALTH   HISTORY   PRIOR   TO    1877  23 

St.  Martin  and  of  Dr.  llcauniDntV  trcalnicin  uf  him.  Tlie  lir'-t  u])inion  was 
that  St.  Alarliii  wDuhl  ilir  InU  then  as  the  jialitnt  inipruvc-fl  liuljliard  wrote 
"about  this  time  the  doctor  announced  that  he  was  treating  his  patient  with 
a  view  to  experimenting  on  hi.s  stomach  being  satisfied  of  his  recovery." 

There  is  evidence  that  French-Canadian  trappers,  traders  and  mission- 
aries added  very  little  to  the  health  problems  of  Illinois.  They  were  almost 
exclusively  ymmg  and  hardy  men.  There  were  no  children  among  the  immi- 
grants, nil  women  and  Ud  nld  men.  When  an  immigrant  loecame  enfeebled 
he  went  l)ack  to  Canada  or  tried  to  do  so. 

By  ]7".'il  out  of  this  movement  an  off-shoot  had  grown.  Some  of  these 
immigrants  had  fnunded  communities  with  the  intention  oi  remaining. 
Father  j\Iarijuetle  had  fdunded  Kaskaskia  on  the  lnw  ground  at  the  junction 
of  the  Kaskaskia  I^iver  with  the  Mississii)|)i.  .V  few  months  earlier  the 
same  type  of  settler  had  founded  Cahokia  in  the  .American  Bottoms  al:)Out 
opposite  a  jiart  (if  ])resent  St.  Louis  .and  abdut  ."id  miles  up  the  river  from 
Kaskaskia. 

The  settlers  in  these  villages  were  some  twenty  to  ime  hundred  French- 
Canadians.  Many  of  them  had  married  Indians;  s(ime  had  luarried  women 
from  Canada  and  from  the  French  settlement  in  Louisiana  carried  there  for 
the  purpose  of  supplying  wives. 

These  imported  indentured  women  were  ipiickly  spoken  f(.ir  when  they 
were  reasonably  cnmely  but  the  record  shows  that  when  the  instalhuent  in- 
cluded the  lame,  tlie  halt,  the  blind,  the  prospective  benedicts  passed  them  by 
and  took  up  s(|uaws.  The  Parkman  account  of  Kaskaskia  recites  the 
rapidity  with  which  the  cabins  of  these  luarrying  immigrants  "began  to 
swarm  with  children." 

If  the  Indian  women  lived  in  a  lent,  wandered  with  her  lord,  kept  her 
baby  at  the  breast  for  two  or  three  years  and  bore  liut  few  children  and  those 
at  long  intervals,  they  were  not  always  emulated  by  their  sisters  who  mar- 
ried squaw  men.  tudk  up  their  residence  in  houses  and  brought  forth  half- 
breeds.  In  additicin  td  these  settlements  there  were  a  number  of  b'rt'nch- 
Canadians  who  settled  up  and  down  the  Kankakee,  along  its  tributaries,  the 
Illinois  and  the  Mississippi,  Most  of  the  half-breed  children  in  time  grew 
U]:)  rather  more  Indian  than  white.  These  went  with  the  Indians  when  they 
mo\-ed  out  of  the  .'~lt<ate.      .V  few  remained. 

Thf  distinctly  b'rench  towns  were  inhabited  b\-  the  descendants  of  the 
all  white  marriages  and  the  half-breeds;  in  mind  ,ind  manner>  more  white 
than  Indian.  In  time  these  towns  were  abandoned  or  lost  their  iM-encb 
flavor.  The  I'rencb  system  (jf  laying  out  towns  and  even  farms,  the  French 
law,  customs  and  language  did  not  persist.  lUit  in  some  of  the  rural  dis- 
tricts in   v.allevs  like  the   Kank.akee  .and   its  ii-iliui;iries  there  is  cunsiderable 


'^4  (;i:.\i;iv.\i.  iii;.\i.tii  iiisToin'  I'uiou  to  IS" 

French  Havor  ami  iradilidii  cvtMi  today.  I  lie  h't'cnch-Canadian  infliU'iice 
was  more  eiiduriiiy  in  the  conntry  than  ii  \va>  in  the  tdwii. 

But  there  is  no  evidence  that  t'itlier  ut'  these  French  niovenients,  if  the 
last  one  can  he  termed  as  >ncli.  added  significantly  to  the  health  prohlem  of 
the  Illinois  territory.  There  was  some  disease;  principally  venereal  disease 
and  I'onsiiniption  in  the  \icinity  of  the  posts  as  has  elsewhere  been  indicated. 
It  is  more  possible  that  smalljHi.x  was  introduced  to  the  Indians  here  and 
tliere  bltt  there  is  no  record  of  ijreat  pestilential  outlireaks  of  any  sort  or  of 
detinite  change  in  disease  t\|ie  i  r  of  an\-  dift'erence  in  the  health  and  \i,ijor 
of  the  [K'ople  in  the  wake  of  this  series  of  intrusions. 

1  lowever,  there  is  not  much  health  history  of  the  period  on  whtch  to  go. 
riie  Indians  were  not  waiters — neither  were  the  trappers.  The  earlv  trad- 
ers of  the  period  wrote  nothing,  though  later  traders  were  more  prolific. 
The  explorers  and  the  mis-;ionaries  were  prolific  writers,  considering  the 
times,  but  they  wrote  about  adventures,  conflicts,  battles,  attitude  of  the 
natives  toward  foreigners,  geogra])hy.  tojiography  and  religion.  In  none 
of  the  reports  of  the  period  i>  there  any  reference  to  the  prevalence  of  ma- 
laria or  any  other  disease  that  is  comjiarable  with  conditions  as  they  were 
described  b_\'  writers  who  observi'd  from  about  1800  onward.  Some  of  the 
dilTerence  nia\'  be  ascribed  to  the  different  interests  and  viewpoints  of  the 
writers,  but  not  all  of  it  can  l)e  mi  interjjreted. 

It  is  not  believable  that  conditions  such  as  were  described  by  these  later 
writer^  could  have  existed  and  lieen  overlooked  or  have  gone  unrecorded  by 
the  Jesuits.  The  conclusion  mu-^t  be  that  the  health  and  vigor  of  the  In- 
dians ;in  dthe  traders  and  trappers,  and  the  French-Canadian  settlers  be- 
tween l(;S(i  ;ind  17S0  was  about  the  same  as  that  of  French-Canadians  and 
lndi;in>  in  .MoiUreal  and  along  the  St.  Lawrence  in  about  the  same  period. 
Just  how  dilTereiil  was  the  pictin-e  soon  after  llsi)  will  appear  in  the  next 
chapter. 

In  the  records  of  the  earlier  \ears  of  the  I'rencb  regime  there  are  few 
alhtsions  to  ,an\-  disease  which  can  be  recognized  ;is  m.'ilaria.  There  are  some 
references  lo  endemics  and  ejiidemics  but  these  cannot  be  interpreted  as 
being  ni,al.iri;i.      In   f.ict.  it  is  difiicult  to  guess  what  the\'  were. 

/euch  '  says,  "In  the  year  KiiO.  the  settlements  in  the  American  P>ottoms 
bad,  in  spile  of  the  stigma  that  had  lieen  placed  upon  them  by  sickness, 
reached  the  size  of  .a  consider.ible  colon)'."  .Most  of  the  colony  were  I'^rench. 
.Most  of  the  sickness  was  ni.alaria. 

A  I'"rencli  religious  order  was  forced  to  .abandon  their  h<ime  in  this 
region   because   of    mal.iria.      ^'et    the   o]iinion    is   genei-al    that    the    l*'rench 

"Zeuch,  Ibid. 


GENERAL    HEALTH    IIISTOKV    I'RIOR  TO    ISTT  "^3 

settlers  in  Illinois  did  not  have  malaria  and  one  writer  is  (|U(>te(l  (elsewhere) 
as  saying  the  French  were  immune.  This  was  not  true  ;  that  the  l'"rench 
have  no  immunitv  to  malaria  was  shown  in   Panama. 

LaKlanc  said  to  de  Lesseps  in  ISSl,  "If  you  try  to  build  this  canal 
(Panama)  there  will  not  he  trees  enough  on  the  Isthmus  to  make  crosses  for 
the  graves  of  your  laborers."  In  lS,s,s,  a  jnurnalist  wrote  "Death  is  con- 
stantly gathering-  its  h.arvest  about  me.  Since  the  ad\-ent  "f  de  Lesseps  on 
Fdiruary  v'S,  Issl,  thousands  upon  thousands  have  been  buried  here." 
Gorgas  estimated  thai  the  I'"rench  lost  a  tntal  (if  one  third  (if  all  their  white 
employees.  "We  estimate<i  deaths  at  "^O.dOd.  .\  \ery  large  pari  nf  these 
deaths  were   from  malaria." 

The  reasims  fur  the  low  malaria  rate  in  ihe  I'rench  regime  in  Illinois 
were  several.  The  earl_\-  settlers  came  frdin  a  nmi-malarial  country  ;md 
brought  in  no  infecli(.in,  the  country  was  sparsely  (iccujiied,  there  were 
ni(is(|uit(ies  but  the\-  were  iKil  infected.  .\s  iiiimigranls  increased  in  number 
and  in  sinirce  Idward  the  latter  jiarl  (if  the  regiiiK-  malaria  increased,  l.'y 
the  lime  the  Urilish  lodk  charge,  the  inos(|uitoes  had  become  rather  generally 
infecud. 
Olln  r  Diseases. 

The  I'Vench-Lanadians  in  lllinnis  had  pneuiiKinia.  rheumatism,  diarrhoea 
and  dysentery.  (  )f  these  diseases  the\'  had  an  abundance.  It  is  probable 
that  they  had  siiialljKix.  whooping  cough  and  dlher  forms  of  contagion. 
lldwe\er.  these  did  not  abound  because  most  of  the  pdpulatidii  were  adults 
and  hardy,  vigorous,  resistant  adults  at  that.  In  additidii,  the  towns,  forts 
and  garrisons  were  small  and  not  crowded.  Communication  was  infrequent. 
Such  other  disorders  and  diseases  as  prevailed  anidiig  adults  in  Canada  along 
the  St.  Lawrence  and  the  L:ikes  in  llu'  period  were  brought  lo  the  Illinois 
terrildiy.  Ibiweyer,  the  b'rench  made  mi  great  CdiUribution  Id  the  problems 
of  hcillh  in   Illinois. 

\\  lun  the  ISrilish  Uidk  (i\er  the  go\enunenl,  man\-  of  ihem  iiKived  away. 
Later  when  ihe  Cdldiiists  took  charge  olhers  departed.  Then  came  the  great 
wayes  of  settlers  from  other  states.  Whereupon  must  of  ihe  b'rench  de- 
parted and  thdse  w  h(i  remained  herded  Id  themselves  in  rather  small  Cdldiiies. 

.''^ince  the\'  did  Udl  man\  much  wilh  ihe  invaders  thev  made  but  lillle 
Cdiitributidn  to  the  conslitulidn  df  the  ]ie(iple.  They  left  behind  them  no 
dUtstanding  di'-eases  df  l'"rench  impdrtation. 

The  tendency  In  inbree(l  and  ui  that  way  lo  li.x  certain  dysgenic  (|uali- 
lies  which  is  ibduglu  to  be  m.irked  amung  the  iM-ench  descendants  in  Illi- 
nois at  the  present  day,  was  iiiil  in  e\idence  during  the  I'rencb  regime.  In 
so  far  as  it  has  been  ,i  Cdiitribnlidn  to  Illinois'  health  or  lack  (if  health  it  is 
chargeable  to  the  l-'rench.  th(inL;b  diily  indirectly  td  the  b'rencli  df  the  b'rench 
retrime. 


26  GEXERAL   JllCAI.lll    IIISTdUV    I'KIOK  TO    1877 

The  British  Regime. 

I'lu'  I'.ritisli  l.ccaiiie  ])oIitically  responsible  for  Illinois  in  KG:!.  l!_v  K'G 
the  coloni^■^  were  in  a  war  to  dispossess  them.  By  1780  British  control  of 
the  region  \\a>  ended,  'rhert'forc.  they  can  he  held  responsible  for  only 
seventei-n  years  of  the  history  of  the  Illinois  rej^ion.  During  that  time  they 
di<l  littK'  more  than  occupy  a  few  garrisons  with  small  bodies  of  soldiers. 
I'lit  the  diseases  and  especially  the  malaria  which  had  been  rolling  up  dur- 
ing tile  latter  ])art  (jf  the  l'"rench  regime  continued  to  mount  while  the  British 
were  in  charge. 

The  following  cpiotations  relating  to  sickness  in  the  Illinois  district  dur- 
ing the  British  regime  are  from  Zciich's  tlistory  of  Medical  Practice  in  Illi- 
nois, Vol.  I. 

"Between  1763  and  1778,  almost  all  of  ihe  journals  of  several  British 
officers  give  harrowing  accounts  of  the  battle  with  their  old  enemy,  malarial 
fever." 

.Morgan's  Journal  (  ITGS)  says:  "Ague  and  fever  has  been  remarkably 
prevalent  in  so  nuich  that  few  of  the  garrison  and  inhabitants  of  Fort  Char- 
tres  and  Kaskaskia  have  escaped.  He  told  them  that  no  native  there  was 
hfty  years  of  age  and  few  were  forty.  Neither  has  any  French  native  been 
known  to  have  lived  to  an  old  age." 

The  Indians  complained  that  small]iii.\  was  transmitted  to  them  b\'  the 
b'nglish   saying  ■'They  ga\-e  us  smallpox   which   made  all   our  children   die." 

Colonel  Wilkin.s  wrote  in  KllS.  "l'',ver\-  officer  and  private  is  violently 
ill  with  fever."  I,ater  Abn-gan  re|iorted  "I'ilty  men  are  now  fit  for  duty 
and  the  tlisorder  has  greatly  abated." 

.Vdjutant  Ihitlerick  rej)orted,  "Three  officers,  twenty-four  men,  twelve 
women  and  fifteen  children  were  sent  to  their  graves  since  September  2!). 
and  manv  more  are  in  a  dangerous  wa\-  though  1  am  in  hopes  the  cold 
weatlu'r  wdl  soon  help  us." 

In  i;s!).  Major  Hamtramck  wrote  to  (ieneral  J.  Harmon,  "The  garri- 
son at  b'orl  Knox  is  very  sickly  .and  disease  had  caused  luore  havoc  than  the 
savages.     Forty-nine  men  are  ill  with  intermittent  fever." 

Zeuch  quotes  Croghan'',  as  writing — ".\11  in  the  garrison  are  ill,  including 
myself.      Out  of  fifty  men  tln're  are  not  abo\e  three  officers  tit  for  duty." 

.Morg.an'  wr(,ite  of  Vnr{  (_'li;irtrt's  lliis  "b'.very  officer  and  private  is 
violenth-  ill  with  fe\er."  liuttrick"  "Thrt'c  olficers,  twenty-tive  men,  twelve 
women  ;md  liftern  children  were  seiU  to  their  graves  since  September  3f), 
and  many  more  are  in  a  dangerous  way". 

"Cl-oglKUl    (inillc.i.s    Hist..ii.nl    ('..ll,-.l  ion.    .\l  \  nid-CaiU-r.    vul.    XI). 
'Trade    ;ina    I'oHtii-s,    17G7-17(;;i,    Illinois    Hisloiitvil    Collection,    Alvord-Carter,    vol. 
XVI. 

"Alvoi-d-Carter,   Ibid. 


GENERAL  HEALTH    HISTORY  TRIOR  TO   1877  27 

At  tliat  the  l'>ritish  left  the  jieople  and  the  country  about  as  they  found 
them,  just  sucli  a  gradual  increase  in  disease  as  is  to  he  expected  when 
nothing  is  done  to  prevent  it. 

Since  the  British  of  the  period  did  not  settle  and  did  not  intermarry  with 
the  Indians  they  made  no  conirihution  tn  the  character  of  the  racial  stock. 

The  Spanish  Influence. 

The  Spanish  made  a  moderately  efteclive  effort  to  cajjlure  and  hoUl  the 
west  bank  of  the  Mississippi  in  the  region  of  St.  Louis.  In  1780  they  sent 
a  company  of  sixty  men  to  St.  Joseph.  ^Michigan,  across  the  southern  end 
of  what  is  now  Illinois.  lUit  neither  they  nor  any  other  Spaniards  remained 
long  enough  in  the  territory  to  alter  health  conditions  for  better  or  worse. 

Zeuch",  rjuotes  the  following  from  the  minutes  of  the  Court  of  Quarter 
Sessions  held  at  Cahokia  in  r;!)'.i.  "In  order  to  keep  off  the  plague  of  the 
smallpox  that  now  rages  on  the  S])anish  side  no  one  was  allowed  to  cross 
the  river  and  goods  brought  from  the  Spanish  side  were  to  be  confiscated." 

The  American  Regime. 

Pkiikji)  1780  TO  1S77. 

There  had  been  some  immigration  into  Illinois  territory  from  the  other 
states  prior  to  1780,  but  it  was  not  until  Clark  occupied  southern  Illinois  in 
that  year  that  the  American  colonists  began  to  dominate  the  picture.  By 
1800  the  po])ulation.  which  had  immigrated  from  other  states,  though  few 
in  number  and  widely  scattered,  were  numerous  enough  to  control  the  social 
life,  the  customs,  habits  and  religion  and  to  shape  such  political  jioiicy  as 
there  was.     'J'hey  shaped  the  disease  history  even  more  markedly. 

ISetween  1800  and  ISKi,  the  ])opulation  increased  in  numbers  but 
the  increase  was  gradual.  After  ISK;  it  was  more  rajiid.  There  were 
two  great  gateways  through  wdiich  the  poinilation  entered.  The  north  end 
of  the  State  was  settled  by  people,  the  great  majority  of  whom  came  through 
Chicago.  Many  of  these  settled  in  the  immediate  Chicago  area;  manv  others 
radiated  northward,  northwestward  and  westward.  \"ery  few  went  south 
of  the  Kankakee  and  the  fllincis  rivers  and  a  line  running  westward  from 
where  the  latter  river  tin-ncd  southward.  In  the  earlier  years,  the  great 
majority  of  those  who  entered  the  State  through  the  Chicago  gatewav  came 
from  New  b'.ngland.  New  ^'ork  and  the  states  west  thereof.  Few  came 
from  those  states  that  bordered  the  Mason-Dixon  line  on  the  north  tltereoi 
and  fewer  .still  from  south  of  that  line.  There  was  little  European  immigra- 
tion. 

"Zeuch,  Ibid. 


28  (;i-:.\i:rai.  uiiai.iii  insidin   rkiou  td  is;; 

1  lie  Miuiln'in  <;atc\\ay  was  less  a  porlal  in  a  physical  way.  It  included 
tlic  W  aliash  basin  sciulh  froni  \'incenncs  and  the  Ohio  valley.  Those  who 
i'i-i>sM(l  these  borders  ]iiisheil  across  the  State,  l^oing  westward,  to  the  brink 
(if  llie  l''rench  settlements  alnnt;  the  .Mississippi  and  north  and  northwestward 
until  they  reached  the  threat  prairies. 

I'lClwecn  the  iriet;ular  frinyedikc  north  li(nnidar\-  of  this  immigration 
wave  and  the  simil.ar  xayut'  sonth  lMiinidar\-  of  the  Chicago  immigration, 
there  \\,is  ,i  bidad  neutral  belt  a  no  nian'>  lami.  The  wel.  stiff-soil  prairies 
made  liei-e  a  natural  geiigra]ihic  barrit'r. 

The  waterways  were  the  great  .arti'ries  of  trans])ortation  and  the  lode- 
stones  of  settlements.  It  wa>  along  the  vtdleys  that  the  people  settled  al- 
most altogether  in  the  --oulh.  and  to  a  large  extent  in  the  north.  In  the 
prairie  si-ction  there  were  no  large  rivers  and  no  great  valleys.  Besides  the 
immigrants  were  a  [leojjle  who  knt'w  the  soil  of  valleys  and  who  did  not 
know  how  to  judge  nor  how'  to  break  or  to  cultivate  prairie  land.  The  bear- 
ing of  .all  lhi>  on  heallh  will  appear  shortly. 

There  were  few  finx-ign  boin  .among  thii~e  wlvi  came  in  through  this 
galewaw  The  Poles  who  pariicipateil  in  the  kt'\ci]ntionary  war  were  given 
large  laud  grants  in  Indiana  tow.ird  the  north  end  of  this  sweep  of  invasion, 
but  tlie\  did  not  come  into  Illinois,  .\niong  the  colonists  wdio  crossed  the 
\\':di.c.h  were  some  luiglish  groups  who  formed  settlements  concerning  which 
some  rt  fcrences  will  be  made.  Willi  few  exceptions  there  were  no  social  or 
religious  or  communistic  colonies  from  foreign  lands  in  this  southern  liiinois 
territory. 

The  majoritx'  of  those  wdio  came  through  this  portal  were  from  the  Ohio 
v.ille\  stales  lo  the  east:  1 'eiinsyl vania  and  \irginia  beyond  the  Ohio  valley 
and  l\(utuck\-  on  its  -nuth.  Hut  not  all  were  from  these  states.  They 
liruugbl  with  them  malaria  ;ind  some  other  diseases  of  the  states  from  whicli 
they  came  to  add  to  the  slock  of  malai-i.i  ;nid  dysentery  with  which  the  coun- 
try was  alri'ady  provided. 

The  (.'oloni.d  period  had  a  heallh  history  that  is  even  more  distressing 
than  tliat  of  the  latter  end  of  the  b'rench  regime  anil  of  the  British  regime. 
In  the  writings  of  llio.se  who  knew  Illinois  .liter  i;si)  and  ])articularly  after 
ISOO.  the  allusions  to  beallh  oi'  r.ilber  ill  heallh  are  fre(|uent  and  illuminating. 
Ilc.dtli  or  kick  of  it   was  pidmineiu  in  the  ])ublic  and  private  mind. 

The  tirriloix  liecauie  a  Stale  in  ISIS,  but  the  newly  organized  State 
ilid  nothing  for  the  heallh  of  the  peopU'.  The  political  change  in  1S18  made 
no  cli.ange  in  hi;ilth  coiidilioiis.  Tlierefort'.  the  health  story  will  be  told 
'v\itlionl  p.irlicukir  notice  of  the  |Hililic;il  idi.angi-  which  occurred  in  ISIS.  It 
will  be  co\(.red  in  the  main  by  sep.arate  treatment  of  several  of  the  more  im- 
portant diseases. 


GENERAL  HEALTH   HISTORY  PRIOR  TO    18TT  29 

With  the  exception  of  a  few  Germans  along  the  Ohio  and  Mississippi 
rivers,  some  Freneh  who  were  ah"ea(ly  here  and  some  IndiaiLs  who  had  re- 
mained, the  population  of  the  State  jiridr  to  the  latter  part  of  tlie  thirties 
decade  were  almost  exclusively  English.  \\  elsh.  Scotch  and  North  Irish  stock. 
Almost  all  were  born  in  the  states  to  the  east  and  southeast. 

l"(.)ward  the  latter  part  of  the  decade,  the  first  great  South  of  Ireland 
wave  began  to  roll  in.  In  the  forties  decade  the  first  great  German  wave  was 
in  evidence.  The  Swedes  and  Norwegians  began  with  settlements  in  Cook. 
Henry  and  Vermilion  Counties.  Their  first  great  wave  began  to  arrive  in 
the  middle  of  the  seventies  decade.  The  Poles  first  tried  some  settlements  in 
Cook  County  and  along  the  Illinois  Central  road  well  to  the  south  and  in  Ogle 
County,  but  their  great  w'aves  of  immigration  did  not  start  umil  well  after 
the  close  of  this  so-called  pre-health  department  pi-riod  |)ri(ir  tn   IST^. 

These  incoming  people  may  have  bniught  with  them  some  of  the  dis- 
eases of  the  countries  from  which  they  came  but  there  is  no  evidence  that 
they  brought  anything  new  in  that  line.  The  peculiarities  of  |ihvsical  vigor 
and  weakness,  of  strength  and  (if  what  is  termed  cunstitutiDU.  were  much 
the  same  as  those  of  the  people  df  the  liritish  Islands  and  of  the  mirthwesi 
fringe  of  Europe,  the  soiux-es  frnm  which  the  Illiiidis  of  that  dav  was  in- 
directly populated. 

GeNER.\L   ITNHE.\LTHKt:LNES.S. 

During  the  French-Canadian  regime,  the  Illinois  terrilor\-  did  not  have 
a  reputation  for  unheallhfuhiess.  Prospective  settlers  were  deterred  from 
settling  b\-  the  reputation  of  the  country  for  danger  from  Indians  and  for 
hardships  due  to  extreme  ciild  and  lack  of  conveniences  but  ihix  were  not 
held  back  by  the  rumors  of  disease  in  the  land. 

By  the  year  ISDO  the  story  was  different.  Disease  had  come  to  be  re- 
garded as  more  of  a  menace  than  tlu-  Indi.an--.  and  ihc  reputation  of  the  coun- 
try for  unhealthfulness  was  both  widesjiread  and  juslihed.  The  settlers  of 
this  jieriod  include<l  the  women  and  children  as  well  as  the  men  of  the  family. 

The  birth  rate  was  high  but  the  death  rate  approached  the  same  level. 
The  Indian  had  a  low  birth  rate  and  a  high  death  rate  and  no  immigration. 
In  consequence  he  increased  very  slowly  in  numbers,  if  at  all.  Certain  tribes 
grew,  others  waned  but  there  were  never  enough  Indi.ms  to  occupv  the  coun- 
try. The  white  settlers  had  a  high  birth  rate,  a  high  death  rate  and  a  great 
immigration  rate. 

The  increase  of  ]iopnlation  due  to  excess  of  births  over  deaths  was  not 
great.  In  fad.  had  these  two  population  factors  opi-rated  alone  the  white 
man  would  have  had  considerable  ditliculty  in  holding  his  own  in  combat  or 
even  in  competition  with  iIk-  Indian.  Hut  the  enormous  immigration  rate 
made  it  ]iossible  for  him  to  drixc  out  the  Indian,  lo  occuin-  the  land,  to  clear 


30  r.KNi-.HAi.  II  i;ai.i  II   lIls^(ll;^    rKioK  to  ISTT 

it,  drain  it,  improve  il,  to  (Icwlop  lln'  resources  ami  rmally  make  the  State 
healthy  and  ])rosperous. 

The  heavy  death  rate  was  due  to  malaria,  diarrhoea  and  other  diseases 
of  infancy  and  childhood,  diarrhoeas  and  dysenteries  of  adidts,  pneumonia 
and  a  few  other  diseases. 

Malaria  so  conifiU'lelv  dominated  the  lieahh  ])iclure  and  its  effects  were 
so  ajjpareni  that  most  of  the  earlier  writings  referred  to  malaria  as  heing 
synonomous  with  ill  health.  Therefore,  the  quotations  of  opinion  and  ob- 
servation found  in  this  section  will  occasionally  be  found  to  say  something 
about  malaria,  and  in  the  section  on  malaria  the  writers  quoted  will  speak 
often  of  the  bad  general  health  conditions. 

Boggess'",  wrote, 

"One  wlio  settled  in  Illinois  at  that  period  (1790  to  1S09)  came  through 
danger  to  danger  for  Indians  lurked  in  the  woods  and  malaria  waited  in  the  low- 
lands. In  17S0  the  garrison  was  sick  and  starving  and  the  abandonment  of  the 
post  seemed  imminent.  One  of  the  earliest  visitors  to  Illinois  to  record  his  im- 
pressions was  an  Englishman  named  Birkbeck.  He  wrote,  'Buried  in  the  depth  of 
a  boundless   forest,   the   breeze   of  health   never   reaches   these   poor   wanderers, 

*  *  *  The  man,  his  wife,  his  son  and  three  daughters.  *  *  *  They  are 
tall  and  pale-like  vegetables  that  grow  in  a  vault  pining  for  light;  a  squalling 
tribe  of  dirty  brats  that  are  of  one  pale  yellow,  without  the  slightest  hint  of  a 
healthful  bloom.  The  blood,  1  fancy,  is  not  supplied  with  its  proper  dose  of 
oxy.gen  from  their  gloomy  atmosphere,  crowded  with  vegetables  growin.g  almost 
in  the  dark,  or  decomposing,  and  in  either  case,  abstracting  from  the  air  this 
vilal   principle.'  " 

JUane",  wrote, 

"The  settlement  has  shared  the  fate  of  all  the  neighborhood  with  regard 
to  sickness:  two  of  the  immigrants  having  died  and  several  others  being  very  ill. 
I  rode  to  Palmyra.  This  most  miserably  dirty  little  village  was  once  the  county 
seat  of  Edwards  County,  an  honor  which  it  lost  in  consequence  of  the  superior 
healthtulness  of  Albion.  Albion  is  not  at  all  times  free  ti'om  the  prevalent 
autumnal  disease  of  ague  accompanied  with  fever.  *  *  *  Wherever  else  I 
traveled  the  people  complained  of  illness.  *  *  *  But  the  great  objection  is 
the  general  unhealthfnlness  of  the  neighboring  country  for  if  Illinois  were  as 
healthy  as  England  it  would  soon  etiual  all  that  Mr.  Birkbeck  has  written  in  its 
favor." 

Speaking  of  St.  Lnuis.  located  immediately  across  from  the  American 

Bottoms,  he  said : 

"St.  Louis  was  once  the  great  emporium  of  all  the  fur  trade  but  of  late  years 
it  has  declined  both  in  prosperity  and  population  partly  owing  to  the  dreadful 
sickness." 

lUane,  speaking  (if  the  .\merican  Bottoms,  eight  miles  before  coming  to 

the  Mississippi  River,  said: 

"This  fertile  district  is  rendered  almost  uninhabitable  by  its  unhealthiness 
and  will  require  a  great  deal  of  draining  before  many  persons  will  settle  upon  it. 

•  *     *     The  French  are  by  no  means  so  liable  to  be  attacked  by  fevers  as  the 

■»  Bogrgess    (The   Settlement   of   Illiiiiiis,    177S-l,s:iO.     Arthur   Clinton   Bogges.s 

Chicago,   1908.      Chicago  Historical   Society   Collection,   vol.   V). 

"Quaife  (Pictures  of  lUinois  One-Hundred  Year.s  Ago.  Edited  by  Milo  Milton 
tjuaife.  Tart  2 — "A  Tour  in  SoiHhern  Illinois  in  1822,"  from  William  Blane.  R.  R. 
Donucllev   .t   H.ms  Coinpany.   Cliicago,    UllS). 


GENERAL   HEALTH    IHSTOKV    PKUIK  TO    IS^^  31 

English  or  Americans.  This  is  attrihuted  to  tlieir  very  different  and  much  more 
temperate  mode  of  living.  *  *  *  x  am  persuaded  that  no  people  on  the  face 
of  the  earth  consume  so  much  animal  food  as  the  Anglo-Americans:  tor  at  break- 
fast, dinner  and  supper,  hot  meat  is  always  eaten,  even  by  the  poorest  class. 
*  *  *  Even  during  the  burning  months  of  summer  and  autumn  they  continue 
to  eat  the  same  immense  quantity  of  meat  and  grease,  which  last  article  is  a 
favorite  in  their  cookery." 

Henry  R.  Schoolcraft'-,  said: 

"The  appearance  of  the  inhabitants  has  corresponded  with  the  opinion 
before  expressed  of  the  uuhealthiuess  of  the  country.  Pale  and  emaciated  coun- 
tenances; females  shivering  with  ague,  or  burning  with  intermittent  fever, 
unable  to  minister  to  their  children,  and  sometimes,  every  member  of  a  numer- 
ous family  suffering  from  the  prevalent  malady  at  the  same  time.  *  «  *  in 
this  country  life  is  at  least  fifty  per  cent  below  paj-  in  the  months  of  August  and 
September.  I  have  often  thought  that  I  ran  as  great  a  risk  every  season  which 
I  spent  here  as  I  would  in  an  ordinary  battle.  I  really  believe  it  seldom  happens 
that  a  greater  proportion  of  an  array  falls  victims  to  the  sword  during  a  campaign, 
than  there  has  of  the  inhabitants  of  Illinois  to  disease,  during  a  season  that  I 
have  been  here.  That  time  and  cultivation  will  remove  the  causes  of  unliealthi- 
uess  is  a  prevalent  opinion. 

"There  are  two  months  of  the  year  when  the  inhabitants  are  exposed  to 
fevers  and  agues  which  render  life  irksome." 

Mrs.  Sarah  M.  Worthington'".  said: 

"By  the  first  of  September  there  was  scarcely  a  well  family  to  be  heard  of. 
and  in  many  cases  not  one  individual  able  to  assist  another.  *  *  *  a  few 
became  discouraged  and  sought  refuge  in  timbered  localities." 

Tillson'^ : 

"A  great  responsibility  which  rested  upon  the  women  was  care  of  the 
family  in  time  of  illness.  An  illness  native  in  the  prairie  country  was  fever  and 
ague.  There  was  a  burning  fever  following  chills  which  left  the  patient  so  weak 
he  could  not  work.     It  came  with  perfect  regularity." 

By  Haines'"',  reference  is  made  to  central  lllinuis  durint;  the  time  f(jllii\v- 

ing  the  Black  Hawk  War  : 

"Time  had  but  little  softened  grief  for  those  slain  by  Indians  when  the 
cholera  spread  a  funereal  pall  over  the  same  territory  lately  stricken  by  war.  The 
swift  flying  messengers  on  horseback  in  pursuit  wherever  to  be  found  dotted  the 
prairies  with  omens  of  dread.  For  when  the  fell  disease  struck  its  victim  no  time 
could  be  lost  before  remedies  were  applied.  Death  was  the  quick  result  if  potent 
relief  was  not  found  within  the  early  hours  of  attack.  In  my  family  four  were 
fatally  stricken  in  as  many  days.  Many  who  were  not  at  once  attacked  fled  their 
homes,  only  to  meet  death  a  little  later  in  the  lonely  prairie  or  unsettled  forest. 
Bereavement  and  sorrow  was  widespread,  almost  universal  over  a  great  part  of 
the  West.  Typhoid  and  other  fevers  followed  this  dreadful  visitation,  swelling 
the  death  list  generally  from  those  who  escaped  the  cholera.  Indeed,  the  'cholera 
year'  as  it  was  long  referred  to.  was  a  period  of  gloom  from  which  memory  turns 
in  horror.  From  this  period  may  be  dated  most  of  our  country  graveyards,  being 
then  set  apart  for  burial  of  our  first  dead." 


'^Quaife,    Ibid.      Part   3 — "A  Journoy    L'l)    the    Illinois   Miver   in    1S21"    from    Siliool- 
craft. 

"  Worthingrton  (Origrinal  Letter  of  Sarah  M. 
a  collection  of  Stories  of  Pioneer  Mothers  in  lUi 
Historical   Library,    Springfield.    lUinoi.s). 

"  Tillson  (Reminiscences  of  a  Pioneer  Woman.) 

"Haines  (Social  Life  and  Scenes  in  the  Early  Settlement  of  Central  Illinois,  p.  35. 
Publication  number  10  of   the  Historical   Library,   Illinois,    1905.     James  Haines). 


32  (lENKUAL  HKAi.Tii   msToin   rNKiR  xn  !STT 

Governor  John  l\c\  niilds"'  says.  "In  ISOO  to  ISO.")  the  idea  ])revailed 
that  Illinois  was  a  i;ra\x'  yard.  'I'liis  retarded  its  settlement.  The  Trapijist 
Monks  abandoned  their  hrst  IncaliDn  in  the  .\nierican  I'.oUonis  in  IS^'i  be- 
cause it  was  near  some  lakes  and  tlu\   bad  bad  health." 

'I'lu-  llist(ir\-  iif  .Medical  I'raclice  in  Illinois.  \'ol.  1.  coni])iled  and  writ- 
ten b\-  Dr.  I.ncins  11.  /eiicb.  and  ]inlili>lic(l  b\  the  Illinois  .Medical  Society, 
has.  as  ils  major  (]l)iecli\  e.  the  bi(i.i;ra|)hics  i)f  medical  men  and  the  history 
oi  ihv  ])ractice  of  nie<licine.  1  luw cwr.  it  ma_\-  be  fairly  said  to  have  the  tell- 
ing- of  llie  Mi)v\  of  (be  health  (if  the  ]ieo])le  as  one  of  ils  ])urposes.  Volume 
1  brings  the  history  down  to   IS.MI. 

The  general  tinhealthfulftess  of  the  ret;inie  and  the  effect  of  such  a  repu- 
talion  on  the  develo]inient  of  the  Cdunlry  in  the  early  days  is  indicated  by  the 
following;  i|notations  taken  from  \'olnme  1  of  thi>  History,  as  follows: 

Tlii^altc's  Jcsiiil  I\i-hifi()iis:  "\  plague  bmke  ciut  amonsj  the  Indians  near 
Cairo.      ll.alf  the  tribe  dieil  and  ibe  survixiir^  fled  in  every  direction." 

In  Aiin-rictui  Xolrs  (  1 S  p.' )  Dickens  describes  Cairo  as  a  detestable 
morass.  The  followinL,r  is  cpioled  from  .Martin  Chuzzlewitt  (Dickens),  "A 
native  of  Cairo  (or  I'^den)  when  asked  to  help  Mark  Tapley  and  Martin 
Cbux/.lew  itl  with  their  luggage  replied,  'My  eldest  son  would  do  it  if  he  could 
but  tiKla\  he  has  his  chill  tipon  him  and  is  lying  wrapped  up  in  blankets. 
.M\  \nungest  son  died  last  week.  *  *  *  We  buried  most  of  'em  here. 
the  rest  have  gone  away.  *  *  *  Tlu'  night  air  aim  c|uite  wholesome. 
Its  deadly  ])oison.'  " 

Zeuch''  sa\s,  "There  were  two  reasims  why  colonization  took  place  in 
the  Kaska^kia  and  C'ali(il<ia  regions  rather  than  in  the  more  healthy  Starved 
Rock  region.  .\n  epidemic  had  seized  the  denizens  of  the  mission.  The 
frosts  did  not  arrest  the  progress  of  the  contagious  malady,  but  just  the 
opjiosite  happene<l."  (The  reference  is  to  an  epidemic  of  unknown  nature 
in  the  1  Uh  centin-y. ) 

In  IMH.  Flagg  wrote  from  Edwards\il]e.  "The  princij^al  objection  to 
this  ciunury  is  its  unhealthfnlness."  In  is-.'o,  Flagg  wrote  from  the  same 
>ection,  "Several  towns  ha\e  been  ver\  sickl)'  this  season  especially  those 
situated  contigumis  to  rivers  nr  mill  ponds." 

On  the  otlier  hand  bordham  wrote  about  the  same  time  and  from  the 
same  section  that  the  cou)itry  was  about  as  healthy  as  England.  "Consump- 
tives are  almost  unknown,  liilious  fevers  are  rather  ])revalent  but  not  dang- 
erous when  attended  to  early." 

The  fdUowing  references  to  disease  in  Illinois  are  taken  from  Zeuch's 
History. 

'"Reynolds  (Mv  own  'rinu-s.  fiiilir:u-iiiK  al.'ii)  tin-  history  of  my  life,  .lolin  Rey- 
nolds, 17Sfl-lS65,  Brll.ville,  Illinois.  11.  H.  I'eirynien  and  11.  I...  Davison,  printers, 
ISoo). 

'■  Zeueh,  Ibid. 


GENERAL   HEALTH    HISTORY   PRIOR  TO   18TT  33 

"The  stigma  of  unhealthfulness  was  fastened  upun  this  region."  f77;c 
reference  is  to  English  Prairie,  i8ig.) 

"The  unhealthy  state  of  the  region  taxed  these  vaHant  Knights  of 
Aesculapius  to  the  utmost."     (The  reference  was  to  Bond  County  in  1844.) 

'Tn  1820  a  sickness  prevailed  in  Pike  and  Calhoun  Counties,  the  nature 
of  which  was  not  determined." 

Writing  of  Ouincy  in  1848,  Dr.  Frances  Drude  said.  "There  was  an 
alarming  mortality  among  the  physicians  due  to  their  exposure  to  contagious 
and  infectious  disease." 

"The  bad  reports  contiimalh'  made  concerning  the  state  of  health  in  the 
west  created  a  fear  that  resulted  in  great  economic  loss  in  immigration  and 
business."  "A  good  settler  must  have  withstood  the  ravages  of  malaria." 
(The  references  are  to  Will  Cminly.) 

"No  other  town  in  the  county  suffered  as  much  from  sickness  as  did  St. 
Charles."      (The  reference  is  to  Kane  County.) 

"The  year  1839  was  known  as  the  sick  year  for  so  nuich  illness  was  prev- 
alent along  the  Mississippi  River  that  few  coulil  lie  induced  to  locate  any- 
where near  it."      (The  reference  is  to  Tiiltuii  County.) 

"On  the  other  han<l  Mcllenry  County  was  reputed  as  distressingly 
healthy." 

Dr.  S.  P.  Hildreth'"  writing  of  Washington  County.  Ohio,  says:    "Since 

the  first  settling  of  the  County  in  1788,  many  of  the  diseases  have  changed 

their  type  and  character."     According  to  Hildreth  from  1788  to  1807  most 

disease  originated  in  expo.sure  to  cold,  hunger  and  fatigue.     The  prevailing 

diseases   were   rheumatism,   the   pleurisies,   pneumonias,    scarlet    fever   and 

smallpox.     Eye  troubles  were  sometimes  epidemic.     In  1797  to  ISO]  jiallor 

anemia  and  consumption  prevailed.     Since   181.").   when   t\'i)hoi(l-i)neuni(inia 

was  so  prominent,  consumjition  has  been  increasing. 

"The  outstanding  diseases  were  pneumonia,  ophtlialmia  and  malaria:  ISOT 
was  our  siclvliest  year.  From  1S07  to  1S13  the  fevers  were  mostly  typhoid.  In 
1823  the  fevers  were  mostly  typhus.  This  typhus.  I  expect,  was  the  same  disease 
called  typhoid  in  the  earlier  reference.  So  general  was  the  sickness  that  in  the 
general  election  of  1823  only  35)0  out  of  a  possible  1200  to  1400  votes  were  cast. 
Measles  and  whooping  cough  appear  at  intervals  of  eight  to  ten  years.  Scarlet 
fever  has  appeared  twice  in  twenty-three  years." 

All  of  these  statements  relative  to  our  sister  state  lying  in  the  same 
parallel  apply  to  Illinois  at  least  in  a  general  way. 

In  reporting  to  the  American  Medical  Association  in  isd:  on  the  c])i- 
demics  of  Illinois,  Dr.  K.  C.  Ilamill  wrote,  "The  testimony  1  ionic  by  the  early 
explorers  and  settlers  was  :inyihing  but  llattcring  its  (  lllinoi>)  characler  for 
healthfulness  and  salubrity." 

'"Hihli-eth    (Amfrir:ni   .Ii.in-nal    Mfdiual    Science,    l.S2tl,    Hr.   .S.    F.    Hildreth). 


34  GENERAL   IIICALTII    1II.ST0K\-    I'KIOK  TO    1  S^  T 

In  1S19  the  1  Hindis  legislature  passed  an  act  authorizing  a  lottery  to 
raise  funds  for  the  ])urposc  of  "draining  ponds  and  lakes  in  the  American 
Bottoms  and  of  improving  the  health  thereof."  In  its  introduction,  this  law- 
says,  "these  ponds  and  lakes  stagnate  and  annoy  the  health  of  the  inhabitant 
of  said  bottom  by  producing  autumnal  fever."  It  appears  that  no  drawings 
were  held  under  this  law  until  1838.  Tt  was  planned  to  hold  the  first  draw- 
ing on  July  1  of  that  year,  "hut  ihc  sickness  of  the  contractor  and  the  gen- 
eral ill  hcahh  (if  the  whole  country,  etc.,  h:ive  caused  this  unlocked  for  de- 
tention and  dcl.iy."  Tlic  first  dr.iwing  took  place  November  17.  1839  at 
ITarrisonvillc.  There  was  a  weekly  drawing  thereafter  for  some  time.  The 
eighth  took  place  at  .\.llon,  January  ."),  1839,  and  the  tenth  at  Harrisonville, 
January  19,  1839. 

'The  lottery  did  not  prosper.  Professor  George  W.  Smith''',  wrote 
"Little  was  accomplished  by  the  lottery  system." 

In  (Jctober  \S'M,  J.  .\.  Townsend,  Manager  of  the  .\merican  Bottoms 
Improvement  .Association  asked  the  owners  of  land  to  ])av  a  voluntary  tax 
of  $1.0(1  an  acre  to  ])ay  for  drainage.  In  .\pril  •21,  1S3S  \V.  C.  Greenup, 
President,  l-ioarcl  of  Managers,  sent  a  cummunication  to  Congress  ask- 
ing that  the  Board  be  given  the  v;icant  land  in  the  .\merican  Bottoms  to  be 
used  to  raise  money  to  pay  for  the  ci)nteni|jlate<l  drainage.  The  following 
extracts  are  taken  from  that  communication — 

"It  is  Ijelieved  that  in  tlie  year  1812  tlie  population  of  the  American  Bottom 
was  greater  than  it  now  is.  This  is  attributed  to  bad  liealth  arising  from  the 
stagnant  ponds  and  lalves.  The  once  flourishing  villages  of  Fort  Chartres,  St, 
Philips  and  Prairie  du  Pont  are  only  known  by  the  ruins  and  the  inscriptions 
over  the  dead.  Cahokia.  Town  of  Illinois,  Harrisonville  and  Prairie  du  Roche  are 
in  great  dilapidation:  Kaskaskia  seems  not  to  advance  although  it  is  reputed  to 
be  the  most  healthful  of  any  other  place  in  the  bottom." 


"Smitli  (Histoiy  nf  Illinois  and  Hcv  Pci.ple,  vol.  2,  Hi27.      Prof.  Oeurge  W.  Smitli). 


HISTORY  OF  CERTAIN  DISEASES  PRIOR  TO  1877. 

Malaria. 

The  dominant  disease  as  early  as  IISO  in  the  Illinois  territory  and  for 
about  seventy  years  thereafter  was  some  form  of  iiialaria.  It  went  by  many 
different  names  such  as  the  "ague",  the  "shakes",  the  "chills",  "bilious  fever", 
"intermittent  or  remittent  typhoid  and  typhus",  "autumnal  fever",  and  vari- 
ous combinations  of  these  names.  As  early  as  1816  Drake  is  found  adding 
the  term  "typhus"  to  several  of  the  malaria  terms.  He  used  the  word  typhus 
sometimes  alone  though  usually  in  combination.  He  did  not  mean  typhus 
as  the  term  is  used  now  and  probably  not  typhoid  in  the  modern  sense  of  the 
word,  but  he  did  mean  a  slow  form  of  malarial  fever  with  oftentimes  a  col- 
lateral typhoid  infection  that  probably  was  about  what  Woodward  ]iiipular- 
izecl  as  "typho-malarial  fever"  sixty  years  later. 

In  the  main,  malaria  was  brouyht  into  the  state  through  the  southern 
gateway  and  by  immigrants  from  the  southern  and  border  states.  Whether 
it  came  to  them  from  Africa  as  a  result  of  the  slave  traffic  as  some  say  is 
not  a  direct  part  of  this  story.  Some  came  in  through  the  Northern  gateway 
brought  by  immigrants  from  elsewhere  than  the  south,  but  most  of  it  was 
brought  in  as  stated  through  the  Southern  gateway.  How  it  was  carried 
north  and  south  in  the  state  as  well  as  east  and  west  will  be  referred  to  pres- 
ently. Once  it  entered,  malaria  found  conditions  fit  for  its  spread.  The 
country  was  undrained,  much  of  it  was  heavily  wooded,  and  mosquitoes 
were  ])lentiful. 

In  IS-?!)  ](>hn  AlacCulloch  wrote  a  book  cm  malriria.  There  is  no  proof 
that  he  had  Illinois  in  mind,  but  what  he  wrote  of  the  region  along  the  Missis- 
sippi river  in  the  south  and  possibly  north  would  apply  to  this  State.  He 
said : 

"In  many  place.s  in  the  southern  States  malaria  has  been  rapidly  increasing 
as  almost  to  threaten  the  abandonment  ot  the  land.  And  in  the  newly  settled 
or  uncleared  lands  along  the  Mississippi  and  its  endless  tributary  streams  the 
same  plague  is  found  to  prevail  very  widely  to  the  surprise  and  serious  grievance 
of  the  settlers.  What  the  fate  of  this  new  country  may  be  ultimately  in  this 
respect  is  difficult  to  foresee.  It  is  to  be  suspected  that  no  changes  and  no  culti- 
vation will  ever  bring  it  into  a  state  ot  salubrity." 

Mrs.  Tillson,  writing  of  Pike  County  in  Illinois  in  1821,  said: 
"Your  father  had  a  shake  of  the  ague.  *  *  *  Feeling  that  he  was  in 
fer  a  smart  grip  of  agy  he  rode  seven  miles  toward  Edwardsville  where  he  stayed 
to  have  another  shake.  The  next  day  being  intermediate  day  he  rode  twenty- 
five  miles  to  Mr.  Hoxie's  where  he  waited  over  there  fer  another  shake  which 
Mrs.  Hoxie  said  "beat  all  the  shakes  she  ever  see.     He  shuk  the  hull  cabin.'  " 

(35) 


3G  IIISTOUV  OF  CICRTAIN   DISEASES  PRIOR  TO    ISTT 

In  Pioncrr  Health  Conditions  by  the-  Norwegian-, Vimricaii  History  So- 
ciety is  t\)Uii(l  tlu'  fcilldwing  statement: 

"Evorywhero  in  the  West  the  ague  attacked  the  settlers  more  or  less  severely 
during  the  first  development  of  the  country.  *  *  *  Wherever  new  land  was 
broken  in  swampy  regions  the  ague  harried  the  people  with  the  most  disastrous 
results.  *  *  *  Malarial  fever  prevailed  in  the  Rock  River  valley  to  the  Mis- 
sissippi River  in  Illinois.  At  this  time  (IS.SD)  malaria  ravaged  Chicago  very 
severely  and  especially  many  of  the  poor  hard  working  immigrants  who  were 
poorly  fed  and  lived  in  miserable  huts,  fell  victims  to  the  disease.  When  fall 
came  only  a  few  were  alive.  Most  of  them  had  succumbed  to  the  unhealthy 
climate.     *     *     *  " 

Sandburg-"  says  : 

"Fall  came  with  miasma  rising  from  the  prairie,  and  chills,  fever,  ague,  for 
Tom  Lincoln  and  Sally  Bush;  and  many  doses  of  'Barks,'  a  Peruvian  bark  and 
whiskey  tonic  mixture,  bought  at  Renshaw's  general  store  in  Decatur,  was 
administered." 

By  long  odds  the  best  informed  man  of  hi^  day  in  the  liealth  nf  the 
people  of  the  Mississippi  \'alley  was  Dr.  Daniel  Drake  of  Cincinnati.  In 
183T  he  wrote  that  in  \><'io,  IS'^7,  l,s28  and  1830  malignant  fevers  were  un- 
usually prevalent  in  the  \N'estern  territory.  Dr.  Drake  gathered  his  informa- 
tion through  travel,  through  correspondence  and  through  articles  sent  his 
j(iurn;il.  There  is  no  proof  that  he  had  visited  Illinois  so  early  as  IS'lo  to 
is;i0.  He  had  one  regular  correspondent  in  the  State,  Dr.  J.  F.  Henry  of 
Blooniington. 

Through  Drake's  travels  and  his  correspondence  he  gathered  the  fol- 
lowing re])orts  on  m.ilaria  in  different  sections  of  Illinois,  particularlv  how- 
ever, in  the  basin  of  the  Illinois  River. 

In  183o-3(;  Drake  made  a  trip  to  St.  I.ouis,  writing  of  the  American 
Bottoms  opposite  St.  Louis,  he  said  ; 

"It  is  among  the  most  fertile  spots  in  the  whole  earth,  but  at  present  it  is 
infested  with  mosquitoes  and  intermittent  fevers,  the  latter  followed  by  enlarged 
viscera  and  dropsical  infiltrations." 

"Bloomington — Autumnal  fever  prevails  annually.  One  of  the  citizens  in- 
formed me  that  he  had  resided  where  I  found  him  three  years  before  a  member  of 
his  family  was  seized  with  that  fever.  Such  instances  are  not  uncommon  though 
difficult  to  explain.  Drs.  Colburn  and  Henry  were  convinced  that  an  extensive 
plowing  up  of  the  soil  of  the  prairies  for  the  first  time  had  been  followed  by  fever 
especially  in  those  who  resided  on  the  northern  or  leeward  side  of  such  tracts. 
They  had  rarely  seen  malignant  cases. 

"Adams  County — We  have  here  in  aiUumn  bilious  diseases  more  or  less  for 
instance  the  ague,  the  intermitting  and  bilious  fever.  In  very  rare  cases  do  these 
diseases  prove  dangerous.  Fifteen  or  twenty  years  ago  the  hepatical  diseases, 
hypohondriasis  and  jaundice  held  such  a  formidable  sway  that  they  spared  but 
very  few,  especially  of  the  immigrants. 

"Woodford  County — In  summer  miasniatical  fevers  prevail.  In  moist  springs 
the  inhabitants  of  the  prairie  suffer  from  them.  In  fall  and  winter  the  abdominal 
typhus  fever  sometimes  occurs,  but  never  real  typhus. 

"Pckin — Intermitting  fevers  reappear  after  the  lapse  of  some  two,  three  or 
four  weeks.  The  best  remedy  is  acid  sulphuric  Peruvian  bark  in  doses  of  from 
2  to  4  grains  at  intervals  until  10,  l.'i  or  20  grains  are  taken.  Tuberculosis  (con- 
sumption)  is  very  rare.     Acute  inflammations  of  lungs  occur  in  winter.     *     *     « 


'  SandbuiK,    (Life  of   Lincoln,   Carl    Saiullmrgr.    Vol.    1,   p.    106). 


^^J^^^es^^T'te^-^,  ^^^^^ 


38  HISTORY  OF  CICRTAIN  DISEASES  TRIOR  TO    1ST7 

"Peru — In  some  casps  of  fliills  :uul  fever  *■■:■*  ^  few  outward  applica- 
tions of  soap  and  water  no  ilouhl  would  have  relieved  the  patient.  *  *  » 
People  drink  surface  water. 

"Tazewell  Count y — They  plowed  up  the  prairie  near  their  residences  and  in 
the  following  autumn  experienced  a  decided  invasion  of  remittent  fever,  while 
the  surroundins  population  remained  healthy.  At  lengtli  a  colony  arrived  and 
establishins  themselves  near  each  other  enjoyed  excellent  health  the  first  year; 
but  the  next  spring  they  broke  up  a  large  extent  of  prairie  near  their  dwellings 
and  suffered  severely  in  autumn  from  fever,  while  the  country  around  remained 
comparatively  healthy.  Dr.  Prye  lias  remarked  what  has  been  noticed  elsewhere 
that  in  low  and  wet  timbered  spots  tlie  intermittent  form  of  fever  is  more  prev- 
alent than  the  remittent — also  that  in  some  autumns  every  kind  of  locality  is 
affected,  while  in  others  some  places  suffer  and  escape." 

Speaking  of  the  especial  iirevalence  of  the  disease  in  the  \aUeys  of  ihe 
Wabash  Dr.  Drake  said : 

"Between  these  wet,  marsliy  prairies  which  will  be  made  dry  by  cultivation 
and  the  bottoms  the  whole  of  this  extensive  and  fertile  portion  of  the  Wabasli 
basin  is  infested  with  autumnal  fever,  of  which  many  cases  assume  a  malignant 
and  fatal  character.    The  people  who  live  in  the  hills  are  healthier  and  live  longer. 

"From  what  can  be  collected  of  the  travels  of  Lewis  and  Clark,  Pike  Long, 
Catlin  Preemont  an  dGregg  not  less  than  from  fur  traders  and  Santa  Pe  mer- 
chants malaria  is  almost  unknown  at  a  distance  of  more  than  300  miles  from  the 
west  boundary  of  Missouri  and  Iowa  and  above  the  37tli  parallel.  To  the  north 
it  does  not  prevail  as  an  epidemic  beyond  the  44th  parallel  and  it  ceases  to  occur 
even  sporadically  at  the  47th  parallel.  It  came  in  from  the  south  and  it  pushed 
up  the  valleys  to  the  north." 

Daniel  Drake-'  writing  of  his  observatii.ms  on  the  distri1)iition  of  ma- 
laria along  the  Illinois  river  and  points  not  far  tiierefroin  in  ihe  period  Ije- 
tween  18-10  and  1845  made  the  following  statements: 

Kuskaskia — "Such  a  surface  must  of  necessity  give  rise  to  severe  autumnal 
fevers  whicli  are  known  to  prevail  throughout  the  whole  Ivaskaskia  basin." 

Lower  Illinois  Valley  around  Mereclosia — "It  seems  almost  superfluous  to  say 
that  the  population  along  such  a  valley  are  subject  to  grave  autumnal   fevers." 

Jacksonville  and  Moryan  County — "Prom  Doctor  Jones  I  learned  that  all  the 
forms  of  autumnal  fevers  occur  at  this  place.  Dr.  Prosser  informed  me  the 
prevalence  of  these  fevers  is  much  less  than  formerly.  Dr.  Smith  thought  them 
not  more  frequent  or  more  fatal  than  ho  had  seen  them  in  the  basin  of  the  Ohio 
River  in  Kentucky.  Dr.  English  had  found  them  more  malignant  than  in  the 
lower  valley  of  the  Great  Kanawha  in  Virginia." 

Sprinyfield  and  Hanyamon  County — "Doctors  Todd.  Henry,  Merriman  and 
Jayne  all  of  Springfield  assured  me  of  the  presence  of  malaria  and  they  afforded 
me  an  opportunity  of  seeing  intermittents  as  malignant  as  those  on  the  banks 
of  the  Tuscaloosa  and  Pearl  Rivers  (Alabama  and  Mississippi!." 

ilaekinaw — "Dr.  Burns  told  me  that  there  was  autumnal  fever  here  and 
there." 

7'cor/a— "In  1833  the  Anglo-American  town  of  Peoria  contained  not  more 
than  twenty-five  families.  But  it  was  the  site  of  an  old  French  mission  and  in 
1779  it  began  to  be  a  village  of  Indian  traders,  voyagers  and  hunters. 

"Although  so  old  a  settlement  its  autumnal  diseases  are  substantially  the 
same  as  those  of  the  more  recently  settled  territory.  From  Doctors  Dickinson, 
Rouse  and  Frye,  I  learned  that  in  and  around  the  town  intermittent  and  remit- 
tents prevail  every  year." 

"  Drake  (A  Systematic  Treatise,  Historical,  Ktiological  and  Practical  on  the  Prin- 
cipal Di.seases  of  the  Interior  Valley  of  North  America  as  they  appear  in  the  Caucasian, 
African,  Indian  and  lisciiiimaux  Varieties  of  its  Population.  Cincinnati,  1S50.  Daniel 
Drake,  M.   D.      Winthrop  B.   Smith  &  Co.,   pub.). 


HISTORY  OF  CERTAIN   UISEASES  PRIOR  TO   1877  39 

Peru  and  LnSaHr—'-DT.  Whitehead  said  in  a  residence  of  eight  years  he  had 
seen  epidemics  of  autumnal  fever  in  only  two  years  and  then  chiefly  in  immi- 
grants from  the  north  and  in  Irish  laborers  on  the  Canal." 

Ottawa — "From  Doctors  How.land,  Schermerhorn  and  Hurlbert  I  learned  that 
autumnal  fever  is  common  in  this  locality.  The  Irish  laborers  on  the  Canal  had 
suffered  greatly." 

Ottawa  to  .Jolirt— "From  the  best  information  I  could  obtain  malarial  fever 
is  both  rare  and  mild." 

JoJie/— "Doctors  Schoolfleld  and  Bowen  told  me  that  Joliet  is  annually  in- 
vaded by  autumnal  fever  but  it  is  neither  widespread  nor  of  a  fatal  character." 

In  1883  Dr.  J.  Murph}'  of  Peoria  wrote: 

"When  I  first  settled  in  Peoria  some  thirty-five  years  a.ao  (about  1S4S)  the 
entire  prairie  was  saturated  with  malaria.  In  fact,  the  entire  area  of  central 
Illinois  was  a  gigantic  emporium  of  malaria." 

In  1842  Dr.  Snuck--  of  Darwin,  Illinois,  Clark  Connty,  wrote: 
"We  have  more  or  less  of  every  grade  of  fever  from  the  simplest  intermit- 
tent to  the  most  remittent  every  year." 

In  ISIo  Dr.  R.  Robson-^,  New  Harmony,  Imliana,  wrote  of  the  fevers 

of  White  County,  Illinois,  and  Posey  County,  Indiana: 

"When  I  commenced  practising  in  1830-31  the  country  (except  the  town  of 
New  Harmony)  was  Infested  with  fevers  of  almost  every  grade.  During  the 
summer  of  1834  very  few  families  escaped  a  visitation  of  fever  and  many  of  the 
most  respected  citizens  were  carried  off." 

in  1843  and  18-1:'±  Dr.  Drake  visited  Illinois,  including  Chicago  and  the 
north  part  of  the  State,  a  considerable  part  of  Wisconsin  and  the  lower 
Missouri  in  his  itinerary.  After  he  had  left  St.  Louis  and  gone  up  the 
Mississippi  to  Alton,  Illinois,  and  some  distance  uj)  the  Missouri,  he  wrote 
of  the  autumn  fevers,  "which  prevail  not  only  on  its  banks  (Alissouri)  but 
far  and  wide  in  all  directions  from  them." 

"I  can  hear  of  no  spot  high  or  low,  wet  or  dry.  wood  or  prairie,  village,  town 
or  city  socalled  that  Is  not  invaded.  To  find  a  sin.s;le  family  some  member  of 
which  has  not  had  a  chill  or  two.  would  be  a  curiosity.  In  one  village  every 
inhabitant  except  one  negro  boy  had  had  the  disease." 

Of  Galena  and  vicinity  he  saiil : 

"The  people  on  the  Fever  River  are  as  free  from  fever  as  their  neighbors; 
meaning  that  they  had  as  much  malaria,  but  no  more.  He  discusses  three  possible 
origins  of  the  name  of  this  river;  one  was  that  it  got  its  name  from  a  Sac  word 
meaning  smallpox;  another  that  it  came  from  the  name  of  a  local  French  trader 
LaFevre  and  the  third  was  that  it  was  derived  from  the  French  word  "feve" 
meaning  bean.  He  did  not  state  his  opinion,  InU  he  did  say  'the  name  is  not 
undeserved.'  " 

In  l<s.")(i  the  Illinois  Medical  Society  was  formed.  In  the  coiistiUition 
of  this  societ\-  there  was  provision  for  a  standing  committee  on  "pr,Lcti':al 
medicine  to  report  annually  on  the  prevalence  of  epidemics  and  other  matters 
of  interest."  The  committee  reported  the  experiences  of  their  members  in 
their  practices,  the  answers  from  correspondents,  about  disease  ])revalence. 

=  Snuch    (WfKtern   iMedical  and   r'liy.si<al    .lounial.    is  12). 

» Uob.son    (Western  Jledical  and  I'hy.siial   .loiinial,    IS!:;,      li.    ll(ilisoii). 


-to 


IIISTOKV  OK  CKRTAIN   DISEASES   I'KIOK  TO    1877 


X.    S.    Mavis 


and  what  tliey  could  k-ani  fnini  reports  before  medical  societies  and  medical 
iournals. 

In  the  ciininiitlee  repurt  I'ur  1^")1  occurred  the  I'ollowing  statement: 
"TIk-  levers  of  ciur  alhnial  fnrniatinii,  interniitteiu  and  remittent  with  their 
various  relatives  claim  the  precedence."  They  especially  referred  to  articles 
on  the  congestive  fevers  which  appeared  in  the 
St.  l.ouis  Medical  and  Surgical  journal.  Jan- 
uary. 1849.  and  January.  IS.M).  In  the  \^'>\ 
report  are  found  eight  references  to  the  several 
tvpes  of  malaria.  In  the  1852  report  written 
l>y  X.  .S.  Davis  and  1..  Hall,  there  are  four 
leferences  to  forms  of  malaria,  and  one  "Isth- 
mian   I'^ever." 

In  18.'")4  Dr.  X.  S.  Davis  reported  to  Chi- 
cago Medical  Society  on  conditions  in  Cook 
(,  ounty  :  "The  attacks  of  ordinary  intermit- 
tent and  remittent  fevers  were  more  frequent 
during  September  than  for  several  years  past." 
lie  also  wrote  that  around  Ottawa  malaria  out- 
ranked other  diseases  in  importance.  In  1835 
Dr.  Thompson's  report  on  practical  medicine 
had  eight  references  to  the  prevalence  of  malaria.  The  report  from  Van- 
dalia  furnished  by  Dr.  Haller  read:  "The  Okaw  river  l)ottom  is  two  miles 
wide  and  it  is  subject  to  inundation.  In  conse- 
quence bilious,  remittent,  intermittent  and  con- 
gestive fevers  prevail." 

Dr.  H.  R.  I'a\ne  nf  Marshall  reporting 
for  Clarke  County  said:  "1-lvery  family  was 
attacked  l:ist  year." 

The  ls.")S  repurt  said  ".Since  the  conipleticm 
of  the  Illinois  and  Michigan  canal  in  ISi;  the 
health  of  the  Des  Plaines  valle\-  has  been  an- 
nually imjjroving,  by  reason  of  the  better 
drainage.     This  is  es].eciall\'  true  in   loliel." 

The  l.s(i()  report  by  Dr.  (iuddbrake  con- 
tains four  references  to  ni:ilaria.  In  1S(m 
ma'aria  is  referred  to  b\  ihrie  ])liv>icians  in 
the  Re  hart  on  Practical  Medicine.    In  the  ISd!) 

'  .  Dr.    Cooilbrake. 

rei)ort  there  are  seven  reports  (jf  malaria. 

.-\fter  that  year  the  subject  was  not  often  referred  to.  -Such  discussion 
of  malaria  as  persisted  shifted  to  new  l);ittlefields — to  wit  :  Is  there  a  typho- 
malarial  fever,  and.  the  relation  of  t\phoid  to  malaria? 


HISTORY  OF  CERTAIN  DISEASES  PRIOR  TO  18T7 


41 


In  the  1864  report  appear  the  following  stateineiits  for  which  Doctors 
J.  S.  Jewell  and  N.  S.  Davis  appear  to  divide  responsibility:  "From  1855 
to  185'  there  was  little  of  disease  except  malaria.  After  1S5T  a  transition 
from  the  periodic  to  the  continued  type  of  fever  occurred.  In  two  or  three 
years  continued  fever  almost  entirely  su])planted  the  autunmal  type."  Just 
how  much  of  the  continued  fevers  referred  U> 
was  typhoid  it  is  not  easy  to  guess. 

In  185G  Dr.  Gerhard  wrote  an  immigrant's 
compendium  of  information  entitled  "Illinois 
as  It  Is."  One  chapter  was  devoted  to  health. 
He  did  his  best  to  answer  adverse  criticism  of 
Illinois  such  as  "When  people  speak  of  Illinois 
in  the  eastern  states  they  will  often  express 
their  fears  in  regard  to  the  fever  and  ague  said 
to  prevail  there."  He  said :  "Everybody 
knows  that  of  all  diseases  the  ague  occurs  most 
frequently  in  Illinois  *  *  *  that  it  depends 
very  much  upon  the  particular  plan  of  abode 
or  manner  of  living  whether  the  fever  is  to 
visit  a  family  or  not.  Whosoever  resides  in 
the  Bottoms  or  close  by  swamps  or  in  districts 

where  the  water  cannot  rapidly  flow  off.  will  be  more  e.xposed  to  the  fever. 
*  *  *  One-half  of  those  who  are  down  with  fever  have  to  ascribe  this  to 
nothing  but  their  own  imprudence  and  the  use  of  improper  food.  Causes — 
drinking  stagnant  water ;  too  immoderate  use  of  fruits,  lard,  eggs  or  fish. 
Nobody  should  expose  himself  needlessly  to  night  air." 

He  had  some  ground  to  talk  since  unciuestionably  there  was  less  malaria 
in  1856  than  there  had  been  thirty  years  before  that  date.  He  quoted  from 
laymen  who  were  very  enthusiastic  as  to  the  healthfulness  of  the  State.  The 
six  physicians  quoted  were  more  reserved.  Dr.  Daniel  Slahl  of  .\dams 
County  said,  "There  is  some  malaria  but  not  as  iinich  as  formerh'.  Diarrhoea 
in  adults  prevailed  somewhat."  Dr.  j.  (i.  l.iller  of  Woodford  C'ounty  said 
the  people  of  that  county  had  some  malaria  in  the  summer  and  some  typhoid 
in  the  autunni.  Dr.  T.  .\.  Hoffman  of  I'eardstown.  Cass  County,  said  they 
had  some  malaria  but  not  as  nuich  as  formerly.  Dr.  l\  Borendel  of  Peoria 
County  said  that  countv  had  some  malaria  and  typhoid  and  the  last  epidemic 
of  cholera  affected  them.  They  had  very  little  consumption.  Dr.  V.  Wenzel 
of  Belleville,  St.  Clair  County,  said,  "The  time  in  which  southern  Illinois 
was  deni)unce<l  as  the  fever  country  had  long  since  passed  by."  Dr.  C.  Hoff- 
man of  I'ekin  said  that  they  had  some  malaria  but  it  was  n(.)t  bad.  They 
were  almost  free  from  consum])tion. 


42  IIISTOKY  OF  CERTAIN  DISEASES  PKIOR  TO   1877 

y.vnch'-'  skives  the  fiilldwiiitj  references  to  the  prc'valenc  ni  malaria  in 
many  of  the  ccmnlies  in  Ihinciis.  The  citations  i;i\c'  the  ^■ear  in  which  the 
presence  of  the  (Hscasc  was  alkuled  to  in  the  orit,'ina!  sources  of  the  mater- 
iaL     In  some  instances  hrief  comments  are  r|Uote(l. 

Shelby  County  in  ISSO:  Moultrie  and  Ed.nar  (^unities  "in  the  early  clays"; 
Sangamon  County  "prior  to  ISoO." 

Vermilion  County,  "It  sought  out  and  attacked  every  new  comer  for  twenty- 
five  years  in  the  form  of  fevers,  fever  and  ague  and  bowel  complaints. 

"A  colony  of  Norwegians  on  Beaver  Creek  was  stricken  with  the  prevail- 
ing illness  of  the  lowlands  and  fifty  of  them  perished.  The  survivors  abandoned 
the  settlement. 

McLean.  Kankakee.  Tazewell.  Will  Counties:  "The  building  of  the  Illinois 
Michigan  Canal  was  stopped  at  times  because  of  the  inroads  the  disease  (malaria) 
had  made  on  the  laborers  at  work  upon  it. 

Kane  County.  "Intermittent  and  remittent  bilious  fevers  sorely  afflicted  the 
pioneers."  Putnam  and  Marshall  Counties,  "particularly  in  1838  and  in  1849." 
Stark  County,  "In  1846  Doctors  Hall  and  Chamberlain  treated  1500  cases  of  fever 
and  ague."    "Up  and  down  the  Rock  River,"  1839.    DeKalb  County  1839. 

Carroll  County.  1837,  "The  pioneer  of  early  Illinois  had  to  suffer  much  from 
malaria  before  he  learned  the  lessons  of  elevation  and  of  restraint  of  the  rampant 
waters." 

Dr.  X'ictor  C.  A'aughan-'  skives  a  graphic  description  of  malaria  as  he 

and  his  family  encountered  it  in  .Montgomery  County  Illinois  in  the  summer 

of  1865. 

"In  1865  every  man,  woman  and  child  in  southern  Illinois,  at  least  within 
my  range,  shook  with  ague  every  other  day.  *  *  *  That  summer  I  saw  enough  of  a 
people  held  in  bondage  by  malaria  to  make  a  lasting  impression  upon  a  boy's 
mind." 

Dr.  X'aughan  describes  a  family  named  Trelaw-ney  as  representing  the 

abyss  of  degeneracy  and  general  incompetence  which  he  inferred  was  the 

result  of  chronic  malaria.     Continuing  the  theme  he  wrote: 

"How  much  the  present  dwellers  in  southern  Illinois  owe  to  the  open  eyed 
and  keen  witted  Jesuit  who  penetrated  the  interior  of  Peru  and  to  his  patroness 
the  Princess  Chincon  I  will  not  attempt  to  estimate,  but  if  quinine  has  clothed 
and  regenerated  the  recent  generations  of  Trelawneys  I  am  willing  to  pronounce 
it  a  gift  frinii  Heaven." 

Dr.  t_'.   r>.  Johnson'-''  writing  of  Bond  C'iiunt\    and  other  regions  in  cen- 

tr;il   Illinois  >ai(l  : 

"lS(i6  yielded  abundant  crops  of  all  kinds  including  malaria  in  all  its 
forms."  Of  the  last  great  endemic  wave  of  malaria  in  Illinois  he  wrote:  "To- 
ward the  close  of  the  summer  of  1872  came  the  last  general  extensive  epidemic 
of  malarial  fever  in  central  Illinois.  The  epidemic  lasted  from  the  last  days 
of  July  till  the  coming  of  a  killing  frost  and  within  the  bounds  of  my  practice 
I  think  almost  no  one  escaped  an  attack.  All  suffered  sooner  or  later  from  the 
infant  at  the  breast  to  the  ohl  man  tottering  to  his  grave." 


=«Zeucli,  Ibid. 

^■■'Vaughan   (A  Docloi-'s   .MpiiiDiie.s). 

^John.son   (Sixty  Year.s  in  Medical  Harness;  or,  Ttir  Stuiy  of  a   r.diis   Mftlical  Life 
1S65-1925.      Charles  Beneulyn   Jolinson). 


HISTORY  OF  CERTAIN  DISEASES  PRIOR  TO  18T7  43 

Clark  Carr,-"  writing  of  northern  Illinois  in  1850  and  thereabouts  gives- 
at  least  one  reason  why  the  fevers  of  southern  Illinois  were  spread  to  north- 
ern Illinois. 

"Large  numbers  of  inhabitants  ot  southern  Illinois  went  to  the  Galena 
district  to  work  in  the  mines  after  they  had  made  their  crops  and  then  returned 
home  for  the  next  crop.  The  roads  in  Henry  and  Knox  County  were  filled  with 
people  emigrating,  every  day  movers  passed  our  house." 

This  was  a  jK-riod  uf  active  building  of  railroads  and  canals  and  duubt- 
less  a  great  deal  of  malaria,  dysentery  and  typhoid  was  spread  through  labdr 
cani]>s. 

Before  leaving  this  subject  the  following  two  references  from  Bartlett's 
"Classical  Work  on  Fevers"  as  to  the  malarial  fevers  and  particularly  the 
element  of  periodicity  therein  are  referred  to.  lie  writes:  "What  reason  is 
there  to  believe  or  hope  that  the  thick  darkness  which  has  ever  wrapped  and 
which  still  wraps  this  fever  so  full  of  mystery  and  wonder  will  ever  be  dis- 
pelled." In  less  than  fcirt)'  years  thereafter  all  of  the  nivstery  had  lieen 
cleared  up;  in  eighty  years  after  Bartlett  wrote,  malaria  had  been  banished 
from  all  but  twelve  counties  in  Illinois  and  it  should  be  easy  to  banish  it 
from  those.  He  also  reports  that  Dr.  Oliver  Wendell  Holmes  once  wrote 
a  prize  essay  on  the  disa|)pearance  of  malaria  from  Xew  England. 

Cholera. 

Hirsch-*  gives  the  dates  of  the  pandemics  of  cholera  as  fi^illows :  first, 
1817  to  1823;  second.  1826  to  1837;  third,  1846  to  1863;  fourth.  186.-,  to 
187--).  The  first  pandemic  is  not  sujiposed  to  have  reached  America.  The 
second  pandemic  reached  Illinnis. 

In  1832  there  were  no  vital  statistics,  but  a  Chicago  Health  Department 
Report  says  that  forty-eight  soldiers  and  several   citizens  died   of   clmlera. 

In  is:il  Daniel  Drake  wrote  of  the  cholera  epidemic:  "Illinois  has  suf- 
fered but  little.  The  Eastern  portion  of  the  State  has  suffered  most.  Some 
villages  have  been  scourged." 

The  following  in  regard  to  Central  Illinois,  folldwing  tb.e  Black  Hawk 
War,  is  qunted  froni  the  Social  Life — Early  Settlement  of  Illinois,  Haines: 

"Time  had  but  little  softened  grief  for  those  slain  by  Indians  when  the 
cholera  spread  a  funereal  pall  over  the  same  territory  lately  stricken  by  war. 
The  swift  flying  messengers  on  horseback  in  pursuit  wherever  to  be  found  dotted 
the  prairies  with  omens  of  dread,  for  when  the  dread  disease  struck  its  victims 
no  time  could  be  lost  before  active  remedies  were  applied.  Death  was  the  quick 
result  if  potent  relief  was  not  found  within  the  early  hours  of  attack.  In  my 
family  four  were  fatally  stricken  in  as  many  days.  Many  who  were  not  at 
once  attacked  fled  their  homes,  only  to  meet  death  a  little  later  in  the  lonely  prairie 

=' Carr  (The  lUini,  a  Story  of  the  Praii-ies.  Clark  E.  c:arr.  Chiiago,  A.  C.  iri:ClurK 
&  Co.      1904). 

=*Hirsch    (Handbook  of  Geographic  and  nistorkal   Patholog.v). 


44  niSTOKV  OK  CKKTAIN  DISILASES  PRIOR  TO  18TT 

or  unsettled  forest.  Bereavement  and  sorrow  were  widespread,  almost  universal 
over  a  great  part  of  tlie  West.  Typlioid  and  other  fevers  followed  this  dreadful 
visitation,  swelling  the  death  list  generally  from  those  who  escaped  the  cholera. 
Indeed,  the  'cholera  year'  as  it  was  long  referred  to.  was  a  period  of  gloom  from 
which  memory  turns  in  horror.  From  this  period  may  be  dated  most  of  our 
country  graveyards,   being  then  set  apart   tor  burial  of  our   first  dead." 

r^arrish''",  wriliny;  of  the  Black  Hawk  War,  l8;iS,  said: 

"Cholera  which  had  appeared  among  General  Winfield  Scott's  troops  had 
detained  them  at  Detroit,  Chicago  and  Rock  Island.  *  *  *  Nearly  one-fourth  of 
his  entire  detachment  of  one  thousand  men  having  died  of  the  pestilence.  *  *  * 
Beyond  this  the  entire  American  loss  in  the  war  was  probably  not  in  excess  of 
two  hundred  and  fifty." 

I'arrish.  writing  of  the  Swedish  Cniony  at  Bishop  Hill,  Henry  Cnuiity, 

ill    llliniiis  s;iid  : 

"During  the  cholera  scourge  of  1S49-52  men  would  go  to  work  in  the  morning 
in  good  health  and  be  dead  before  sundown." 

Imoiii  is;!;  (or  1838)  until  IS  1(1  liirsch  says:  "Europe.  Africa  and 
America  were  ccnnpletely  free  frcmi  chcilera." 

In  the  third  pandemic  the  disease  was  widely  prevalent  and  highly  fatal 
in  Illinciis.  It  is  mentioned  in  the  A'c/ioc/.s-  on  Practical  Medicine  in  18."51, 
1852,  1853,  1854,  and  1855.  In  sduie  nne  of  these  reijorts  Jerseyville  is 
quoted  as  congratulating  itself  in  escapint;-  the  epidemic,  attrihutintj  it  to 
having  appointed  a  local  hoard  of  health  and  to  the  excellent  woik  done  hy 
the  board.  Chicago  also  appointed  a  new  l)oar(l  of  health  whenever  cholera 
was  seen  coming  down  the  road  (or  down  the  lake  or  up  the  river),  Imt  it 
was  not  so  fortunate  as  Jerseyville. 

The  Transactions  of  tlic  Illinois  Medical  Society  reported  cholera  in 
lS(;ii-lSiM  and  IStiS.  It  was  also  present  in  1S';3.  By  somewhere  toward 
the  end  of  ISC.'.  the  fourth  pandemic  was  at  hand  and  cholera  was  again  in 
Illinois. 

The  Committee  on  Practical  Medicine  reported  its  wide  prevalence  in 
l.s()G  and  18GT.  Dr.  P.  AI.  Cook,  reporting  in  1868  said,  there  were  1582 
cases,  970  deaths  in  Chicago  in  Isii;  :  1082  ca.ses  were  reported  in  October. 
October  10th,  175  cases  were  re|)orted.  The  population  of  that  city  in  that 
year  was  given  as  200,330.     In  1868  the  disease  still  prevailed. 

Zeuch^'  gives  the  following  instances  of  epidemics  in  several  counties: 

White   County,  in   1832,   1S4S,   1856,   1866  and   1873. 

St.  Clair  County,  1832.  Governor  Edwards  died  of  the  disease  in  this  epi- 
demic in   Belleville. 

Sangamon  County,  1849. 

Morgan  County,  lS:i3.  "Thi'  little  village  of  .Jacksonville  received  a  set 
back  when  cholera  took  a  toll  of  fifty-three  deaths." 

Greene  Couuty.  1S44.  "An  epidemic  of  cholera  destroyed  fifty  of  the 
stru.ggling  colony  (Carrollton)." 

» Parrish    ( ilisloiic    iniiiois.    tlie    i-(imance    of    the    earlier    days.      Randall    Pni-rish. 


HISTORY  OF  CERTAIN  DISEASES  PRIOR  TO   1877  45 

Adams  County.  1S49.  1S50-1S51. 

Vermilion  County.  1S34. 

Fulton  County,  1S49. 

Henderson  County.  1S49. 

Tazewell  County,  1834.  1S44.  1849. 

Will  County.  1844  to  1854.  "The  epidemic  left  in  its  wake  a  case  mortality 
of  60  per  cent. 

Kane  County.  1849,  "The  Colony  of  Swedes  at  St.  Charles  was  almost  deci- 
mated by  it." 

Putnam  and  Marshall  Counties  in  1849.  "Cholera  killed  143  in  the  Swedish 
colony  at  Bishop's  Hill." 

"In  1832  cholera  was  mostly  in  the  cities,  but  by  1834  it  had  reached  the 
rural  populations." 

Short's  History  of  Morgan  Caitiily  rciiurted  an  epidemic  of  cholera  last- 
ing six  weeks  in  Jacksonville  in  the  summer  of  18o3.  "In  ISol  cholera 
visited  Morgan  County;  the  path  of  the  scourge  was  a  narrow  strip  south- 
ward as  far  as  Belleville." 

The  Springfield  Journal  published  a  letter  Alay  26.  1852.  from  Cairo 
which  said  "Cholera  has  been  prevailing  here  for  the  past  two  weeks  prin- 
cipally among  recent  German  immigrants.  Ten  or  twelve  have  died.''  June 
]4:th  the  same  paper  printed  a  letter  from  Walnut  Crove  which  said.  "There 
had  been  some  fatal  cases  of  cholera  in  Woodford  County." 

The  Bloomiugton  Intelligencer  corroborated  this  report  of  the  death 
from  cholera  in  that  city  of  a  man  who  had  recently  returned  from  a  visit 
east  and  on  the  river.  June  T.)th  chcilera  was  reported  in  LaSalle,  Illinois, 
but  reputed  as  under  control. 

June  22nd  the  Monmouth  Atlas  re]iorted  that  cholera  which  had  lieen 
under  control  in  Warren  County  had  reappeared.  Dr.  Wright  who  had  been 
attending  the  cholera  cases  was  one  of  those  who  died  of  the  disease. 

The  Springfield  Journal  on  May  ISth  reported  cholera  at  Cairo  and  at 
Peoria. 

The  ligyplian  Republican  {]\mii  i;i,  l'J27)  writing  of  Williamson 
County  said : 

"Cholera  made  its  first  appearance  in  July.  1849,  but  caused  only  a  lew 
deaths.  It  reappeared  in  1866  and  lasted  for  six  weeks  during  which  over  twenty- 
five  persons  were  taken  away  and  the  city  of  Marion  vacated.  Among  the  de- 
ceased were  the  three  beautiful  Ferguson  girls,  ladies  without  parallel  in  all 
the  area  for  beauty  and  refinement." 

In  1867  the  Illinois  Medical  Society  had  a  red  hot  debate  on  the  eating 
of  fruit  during  an  epidemic  of  cholera.  Those  who  participated  in  the  debate 
were  Doctors  J.  Adams  Allen,  who  introduced  the  motion,  David  Prince, 
W.  S.  Edgar,  E.  Ingals,  T.  F.  Worrell,  1).  W.  ^■.lung,  11.  A.  Johnson  and 
N.  S.  Davis.  The  resolution  was  aimed  at  the  authorities  of  St.  Louis  who 
had  tried  to  .stop  the  eating  of  fruit  during  the  prevalence  of  cholera.  The 
resolution  which  tinally  carried,  re.id  ;is  follows:  "The  moderate  use  of 
ripe  but  not  stale  or  decayed  fruit,  taken  at  the  ordinar_\-  meals,  is  not  ob- 


4G  IIISTOKV  OK  CKUTAIN   DISEASES  PRIOR  TO  1877 

jectionable  as  tending  to  produce  cholera,  hut  ratlier  is  conducive  to  the  pres- 
ervation of  health  during  the  hot  season." 

L.  T.  Ilcwins  of  Loda  (Committee  of  Practical  ^Medicine)  reported 
cholera  jircsent  in  IS(ir)  in  Alexander,  Coles,  Champaign,  Cook,  Iroquois,  and 

])r()lial)lv  other  ciiuiilies. 

Yellow  Fever. 

The  mos(iuitoes  which  act  as  vectors  of  yellow  fever  are  found  in  the 
southern  end  of  the  State,  yet  there  are  only  two  records  of  epidemic  of 
yellow  fever  in  the  State.  In  August,  September  and  October  1878  yellow 
fever  prevailed  in  Cairo,  Illinois.  In  all  there  were  eighty  cases  of  the  dis- 
ease with  sixty-two  fatalities.  In  that  year  an  extensive  and  highly  fatal  epi- 
demic prevailed  in  the  lower  Mississippi  River  Valley.  The  nearest  point  to 
Cairo  reached  by  the  disease  prior  to  its  appearance  in  Cairo  was  Hickman, 
Kentucky.  By  a  strange  irony  it  appeared  first  in  the  household  of  the 
Cairo  Bulletin  whose  editor  had  been  active  in  stimulating  the  authorities 
to  clean  up  Cairo  and  simultaneously  in  trying  to  caln;  their  fears. 

So  far  as  the  record  shows  the  disease  prevailed  solely  among  residents 
of  the  city  of  Cairo  and  it  did  not  spread  to  any  nearby  city  nor  to  the  sur- 
rounding country.  Just  who  brought  it  into  the  city  was  never  known.  The 
first  case  w"is  the  father  of  the  publisher  of  the  Bulletin  and  he  died  in  the 
Bulletin  office.  Later  the  editor  and  two  printers  of  the  Bulletin  died  with 
it.  The  disease  abated  in  September  and  the  schools  opened,  but  it  reap- 
peared in  October  and  lasted  until  the  frost  came  in  the  latter  part  of  the 
month.     r)n  October  (ith  there  were  six  deaths  from  it. 

Perhaps  this  epidemic  was  sent  as  a  baptism  of  fire  for  the  infant  State 
Board  of  Health. 

On  several  occasions  cases  of  yellow  fever  have  developed  among  ref- 
ugees in  Chicago.     There  have  never  been  any  secondary  cases. 

An  accnunt  of  a  small  outlireak  at  Centralia  is  found  elsewhere  in 
lhi>  volume. 

Dengue. 

Jn  18'2.S  there  was  almost  a  iiandemic  of  dengue  called  by  some  the 
Spanish  fever.  It  travelled  a  long  distance  u])  the  Mississippi  River  but 
there  is  no  evidence  that  it  w-ent  north  of  the  3-lth  parallel,  and  Illinois  prob- 
ablv  escajied.  There  is  no  record  that  the  people  of  Illinois  ever  suffered 
I'n.ni  dengue.  Since  the  mosquito  which  spreads  this  disease  is  closely  re- 
lated to  the  varietv  which  sjireads  yellow  fever  and  since  this  type  of  mos- 
quito is  onlv  found  in  the  southernmost  part  of  the  Slate,  dengue  should 
never  menace  Illinois. 


history  of  certain  diseases  prior  to  18  i  7  47 

Snake  Bite. 

In  the  early  Illinois  days  snake  bite  was  frequent.  [Many  fatalities  re- 
sulted. 

In  the  Reports  of  the  Committee  on  Practical  Medicine  snake  bite  was 
reported  on  in  1852.  In  1854  Dr.  Daniel  Brainard  made  snake  bite  the 
subject  of  his  presidential  address  before  the  State  Medical  Society.  He 
did  a  great  deal  of  scientific  research  work  on  the  subject.  He  said  Indians 
used  rattle  snake  venom  on  their  poisoned  arrows.  He  showed  that  the 
whiskey  cure  was  worse  than  useless.  He  advocated  local  treatment  with 
iodine. 

Snake  bite  figured  in  other  discussions  before  the  medical  societies.  As 
the  country  became  more  densely  settled  and  the  land  better  cleared  snake 
bite  as  a  menace  to  health  and  life  disappeared.  The  favorite  remedy  for  it, 
whiskey,  remained  as  a  menace  for  a  long  time  afterward  though  its  use 
(as  a  remedy  for  snake  bite)  is  about  to  become  legendary. 

TvPHus  Fever. 

llirsch"-  makes  the  statement  that  he  never  found  a  single  reference  to 
typhus  fever  in  the  Mississippi  Valley.  It  is  probably  true  that  European 
typhus  never  invaded  Illinois.  In  about  1916  there  were  a  few  cases  among 
Mexican  laborers  along  the  Santa  Fe  railroad  within  the  State  but  the  au- 
thorities prevented  it  from  spreading.  It  is  also  true  that  cases  of  Brill's 
disease  or  modified  typhus  have  been  reported  from  Illinois  but  it  is  a  state- 
ment of  essential  fact  to  say  that  in  the  period  of  Illinois  history,  now  under 
consideration,  typhus  was  never  present. 

Drake''^  says  that  Indians  were  infected  with  typhus  from  a  ship  at 
Nantucket  in  1763,  but  no  evidence  is  found  showing  that  typhus  ever 
reached  the  Indians  of  the  Illinois  regimi.  Drake  writes  abinit  Irish  immi- 
grant fever,  but  mentions  no  cases  in  Illinois  and  Indiana.  -Vnd  yet  the 
disease  is  rather  frequently  referred  to  in  the  writings  of  physicians  and 
even  in  the  reports  from  the  Chicago  Health  Department.  It  must  be  re- 
membered that  Louis  did  not  difTerentiate  typhoid  fever  from  typhus  until 
1s-.':i,  and  his  views  were  not  generally  known  in  Illinois  until  at  least  ten 
years  later.  Som.e  of  the  references  to  typhus  in  these  earlier  reports  re- 
ferred to  typhoid  and  some  of  the  low  delirium  .stages  of  malarial  fevers  and 
other  diseases. 


'  Hirsch,  Ibid. 
I  Drake,  Ibid. 


First  health  officer  of  Chicago,  appointed  in  1S37.  He 
was  probably  the  first  municipal  health  officer  reg- 
ularly appointed   by   a   board   of  health   in   Illinois. 


HISTORY  OF  CERTAIN  DISEASES   PRIOR  TO   18T7 


49 


When  the  controversy  over  t}-phoid  was  warm.  Dr.  E.  P.  Cook  of  Men- 
dota  said  he  had  seen  typhus  in  Ireland  and  what  he  saw  in  this  country  that 
was  called  t^■phus  was  not  the  disease  he  saw  under  that  name  in  Ireland. 
Mirsch  probably  overlooked  the  definite  re- 
ports of  tv])hiis  "jiven  in  some  instances  by 
street  location  found  in  the  Rrports  of  the 
Chicago  Health  Dcpartninit  in  18(3T,  1868  and 
isd!).  The  diagnosis  in  these  cases  was  prob- 
dblv  erroneous  but  Mirsch  had  no  way  of 
kn(}win<;-  that. 

(  )ne  sometimes  wonders  how  llirsch 
tailed  to  read  the  so-called  Ranch  Report  of 
thi  Chicaf/o  Health  Department  made  in  IS'io 
or  IS'Il.  Hirsch's  Handbook  is  encyclopedic. 
He  seems  to  have  had  access  to  nearly  all  the 
literature  of  the  world,  yet  somehow  he  seems 
to  have  missed  this  Ranch  report  and  in  spite 
of  some  of  the  mistakes  found  in  it  we  know 
of   no   American    re]iort   of   the   {:)eri(.i(l    which 


compares  with  it. 


Smallpox. 


Smallpox  was  a  disease  of  the  Indians.  It  was  brought  to  them  by 
white  men,  but  just  when  is  not  known.  It  may  have  been  among  the  Illi- 
nois Indians  at  the  time  of  the  French-Canjidian  occupation,  but  there  is  no 
proof  of  the  fact.  It  was  elsewhere  and  it  is  not  easy  to  understand  why 
the  Illinois  Indians  escaped  if  they  did. 


Drake  ■'  wrote : 

"Smallpox  has  penetrated  far  into  the  wilderness  and  proved  extremely 
mortal  among  the  Indian  tribes.  Ross  tells  us  the  chief  remedy  used  by  the 
Indians  for  smallpox  was  to  pour  cold  water  over  the  patient.  It  was  a  period 
in  which  smallpox  was  very  prevalent  and  highly  fatal  among  the  Illinois  popula- 
tion. It  came  in  periodic  epidemics  and  most  of  these  were  due  to  a  violent 
virus.     Vaccination  was  not  general." 

Catlin-'"'  says  ; 

"Trade   and   Smallpox   were   the   prin<-ipal   destroyers   of   the    Indian   tribes." 

Hrdlicka,  writes  of  the  Southwest  Indians  of  our  times  what  has  been 
true  of  Indians  for  a  hundred  years  or  more.  "Smallpox  is  the  most  dan- 
gerous contagious  disease."  This  disease  has  plagued  the  white  man  ever 
since  he  landed  in  America  and  for  that  matter  long  before. 


"Drake,  Ibid. 

3'Catlin    (North   American   Indian.s 


nin:!).     I'lil). 


50 


HISTORY  OF  CERTAIN  DISEASKS  PKIOK  TO   1877 


1  iirsch'-'',  spcaUinsj  of  smallpox  in  America  says  to  whatever  places  the 
Euro])ean  inimisjrant  camr  ami  scttU-cl.  everywhere  thev  carried  the  disease 
willi  llieni  and  i^axe  it  to  the  natives.  i5ut  a  still  mure  lerrihle  sdurce  for 
.America  \\a>  tin-  ini])iirlatii>n  ot'  nciiin  sla\es.  livery  fresh  outbreak  of 
smallpox  could  he  traced  tn  importalinn  fmm  Africa. 

Table  I. 

Deaths   fko.m   Smai.li'ox — City   of   Chicago. 

Rates  Per  100,000  Population. 

1S6T-19-26. 


1867 
1868 
1869 

IS70 

1S71 
1872 
1S73 

1S74 


1876 
1877 
1878 


1881 
1882 
1883 
1884 
1883 


1887 
ISSS 
1889 
1.S90 

1891 
1892 
1893 
1894 
1895 


1898 
1899 
1900 


1901 
1902 
1903 
1904 
1905 


1911 
1912 
1913 
1914 
1915 

1916 
1917 
1918 
1919 
1920 

1921 
1922 
1923 
1924 
1925 


0.04 
0.14 


Wherever  it  came  from  and  whatever  the  source  of  reinforcement  small- 
pox was  present  somewhere  in  the  State  practically  all  the  time  after  1S40 
and  it  was  epidemic  somewhere  in  many  of  the  years. 

The  Reports  of  the  Cominittee  on  Practical  Medicine  refer  to  the  dis- 
ease in  1S,')2,  1855-1857,  1858,  1869,  lS7v.  and  1875,  as  being  epidemic  in 
one  or  more  counties  in  the  State. 


'Hirsi'h,  Ibid. 


HISTORY  OF  CERTAIN  DISEASES   PRIOR  TO   18T7  51 

The  Annual  Reports  of  the  Chicago  Healtli  Dcparlincnt  shows  that  the 
disease  was  prevalent  in  that  city  in  every  year  lictwecn  ISG?  and  ISSS  (See 
Table  No.  1.)  It  was  present  in  epidemic  prujiortions  in  many  years  jjrior 
to  1867. 

Among  the  reports  of  smallpox  epidemics  in  lllinnis  found  in  Zeuch's 
History  of  the  Practice  of  Medicine  are: 

Henderson  County  in  1854  and  1855  and  Kankakee  County  in  ]8.'!7-;iS. 
The  account  says:  "Smallpox  ravished  the  settlements  during  the  winter 
of  1837-38."  A  history  of  Williamson  County  (Egyptian  Republican  June 
JJ,  ig^y)  says,  "The  smallpox  has  visited  the  county  on  several  occasions  but 
never  resulting  in  nu'un-  deaths  until  1S7  3  when  a  good  many  died  in  the 
south  side  of  the  cuunty." 

Erysipel.\s. 

The  student  who  considers  the  prevalence  of  the  different  diseases  in 
Illinois  in  the  first  seventy-five  years  of  the  nineteenth  century  is  struck  by 
an  apparent  relationship  of  a  group  of  diseases  now  known  to  be  due  nr  in 
some  instances  suspected  of  being  due  to  members  of  the  streptococcus  group. 
The  diseases  referred  to  are  erysipelas,  scarlet  fever,  puerperal  fever.  se])ti- 
cemia  and  rheumatism.  In  the  early  days  these  diseases  were  very  prev- 
alent. In  many  cases  they  swept  over  communities  in  epidemic  proportions. 
Furthermore,  their  case  fatality  rates  were  higher  than  in  the  present  day. 
One  of  the  significant  improvements  in  the  last  half  century  is  the  lessened 
prevalence  and  the  lowered  virulence  of  most  members  of  this  group. 

In  Ma\-,  l'.i".'7,  R.  M.  Atwater-'",  writing  of  the  relatii)nship  of  this  group 

of  infective  disorders,  said: 

"When  rheumatic  fever  is  compared  with  scarlet  fever,  chorea,  erysipelas. 
septicemia  and  puerperal  fever,  it  is  seen  that  the  trends,  as  well  as  the  yearl.v 
oscillations  of  these  diseases,  are  alike.  Acute  rheumatic  fever  appears  to  be 
related  to  the  family  of  streptococcal  infections.  There  is  a  community  of  rela- 
tionship between  these  diseases.  This  correspondence  appears  in  the  United 
States,  as  well  as  in  the  English  records  where  it  may  be  traced  back  as  tar  as 
seventy-five  years." 

In  the  early  history  of  the  State  erysipelas  was  l)oth  freipient  and  fatal. 
At  times  it  swept  over  the  country  in  well  marked  epidemics.  In  spite  of  the 
fact  that  the  sick  were  generally  cared  for  in  their  homes  and  hospitalization 
was  rare,  the  disease  was  regarded  as  contagious  at  least  in  certain  epidemic 
outbreaks.  Some  relations  to  puerperal  fever  and  hospital  gangrene  and 
perhaps  other  infections  were  guessed  at  here  and  there  and  at  intervals. 

A  study  of  ei)idrmic  erysipelas  made  by  Dr.  l'',ihnund  Andrews  in  Chi- 
cago in  1808  will  be  fnund  in  the  section  dealing  with  Chicago.     He  made 

^'Atwaler  (American  Journal  of  Hygiene). 


52  1IIST0R\'  OK  CERTAIN   DISEASES  PKIOK  TO   1877 

spot  maps   of   the   disease   and   tried   to  show   its   relation  to  the  very  foul 
stretches  of  the  Chicago  River  and  to  badly  sewered  sections  of  the  city. 

in  ls|;;  and  ISII  their  \\a>  a  ^real  epidemic  of  erysipelas  which  was 
rc])oited  by  Doctors  J.  1*".  IKnry,  and  Lnlliurn'^  of  i!loomin<;;ttjn.  'i"he\'  re- 
ported that  the  disease  came  from  the  Mast  and  that  the  ejiidemic  extended 
far  beyond  the  boundaries  of  the  Slate. 

One  of  the  names  by  which  erysipelas  went  in  that  early  day  was  "Ijlack 
tongue".  Dr.  Meeker-'"  of  Rush  Medical  College  wrote  a  paper  in  May, 
ISKi,  on  black  tongue  or  eijidemic  erysipelas,  as  it  appeared  in  LaPorte 
County.  Indiana.  He  said  the  epidemic  first  appeared  in  Canada.  During 
the  \\  inter  of  1842  notice  appeared  in  the  public  papers  of  an  epidemic  pre- 
vailing along  the  Illinois  River  called  the  black  tongue.  It  was  extensive 
and  highly  fatal  in  Lal'orte  County  in  isi.').  In  18  Ui  Ur.  l-'itch''",  reported 
the  ])revalence  of  the  same  epidemic  in   Logansport,  Indiana. 

In  Drake's"  writings  erysipelas  is  fre(|ueiitly  rejjorted  under  the  name 
"Black  tongue". 

In  18(11  Dr.  N.  S.  Davis,  in  reporting  for  the  committee  on  practical 
medicine  said:  "Those  epidemic  diseases  chiefly  worthy  of  mention  are 
erysipelas  and  cerebrospinal  meningitis.  Coincidently  with  the  presence  of 
erysipelas,  typhoid  and  typhoid-pneumonia  were  unusually  prevalent.  There 
was  a  wide-spread  epidemic  influence  of  a  tophus  ty])C."  At  that  date  Dr. 
Davis  could  not  get  awav  from  the  use  of  the  word  typhoid  in  describing 
ciinditions  of  low  vitalit\-  regru'dless  of  llie  disease  which  caused  them.  He 
more  or  less  connected  together  all  diseases  in  which  <leliriuni  and  other 
sym|)toms  of  that  class  were  present. 

In  the  Report  of  Ihc  Committee  on  Practical  Medicine  of  the  Illinois 
.Medical  ."^ocietv  there  are  reports  on  erysipelas  in  18.")1.  18.").j,  18li().  1803, 
isd  I.  iscii  an<l  is:);. 

The  18ii:i  i-eporl  treated  especi.alh'  of  hosijital  erysipelas  in  connection 
with  g;uigrene  and  suppur.ition  and  olln'r  ettects  of  crowding  in  war  hos- 
pitals. 

Dr.  Sanuiel  Thomi)son  t  Committee  on  Praclieal  Medicine  'Sj^i)  said 
"Krysipelas  the  fatal  nialailv  made  ils  a]ipear;uice  in  l*"d\\ards  and  neighbor- 
ing counties  in  1844-4."i". 

»Cc>lbiirn    (W.stirii    .M,di,-.il   ami    I  •|i.\  sii:i  I   .Iciirual  ). 
:»Dr.  Mi-ckir   (III.  :in<l   liid.   :Mi.<lii:il  .iiiil   SiiiKiral   .l..miiMl). 
"Fitch    (111.   .-nirl    liul.    .M.di.al   anil    SinKiral   .loiiiiial). 
"  Drake-,    ibid. 


HISTORY  OF  CERTAIN  DISEASES  PRIOR  TO   18?7 


53 


Dr.  Nance  of  Lafayette  said  an  e])i(leniic 
town  in  1859. 


if  erysipelas  prevailed  in  his 


Dr.  Win.  Massie  of  Grand  View,  Edgar 
lllunt^•  I  Cdiiniiittcc  on  Practical  Medicine 
iSjf))  (|U(itecl  Dr.  j.  S.  \\hitniure  of  Aleta- 
ninra.  Wdddfnrd  (.dunty.  as  saying  erysipelas 
and  puer])era!  fever  go  hand  in  hand.  With 
this  he  agreed. 

Zeiich'-  quiites  a  plivsician  as  saying  of 
Kane  CiunitN'  when  it  was  first  settled.  "Ery- 
sipelas   was    nuire    malignant    than    it    was    in 

is;,s." 

In    isii;     Dr.    I  laniill    told    the    American 
.Medical  .Vssociaticm  ahont  two  great  epidemics 
of   erysipelas  in   Illinois.     One   was  the   great 
Chicago    epidemic    of    l<S(i3    reported    hy    Dr. 
L)r   Wm    Massie  ^-    Andrews    and    referred   to    elsewhere,    the 

other  was  a  report  by  Dr.  McV'ey  (if  an  epi- 
demic in  Morgan  County  in  18(14  of  which  McVey  said,  "Erysipelatous  fever 
which  has  far  exceeded  in  fatality  even  cholera  itself." 

Scarlet  Fevkk. 

Drake^^  says  : 

"Between  1791  and  1793  scarlet  fever  invaded  the  settlers  in  Kentucky  and 
Ohio.  It  was  called  'putrid  sore  throat'.  From  1793  to  ISOS  I  do  not  know  that 
any  form  of  scarlet  fever  appeared  in  the  Ohio  Valley.  Since  1S21  for  twenty  to 
twenty-five  years  at  no  time  has  evidence  of  scarlet  fever  been  absent  from  the 
Valley  of  the  Mississippi  and  the  Lakes.  The  epidemics  in  the  north  are  more 
frequent  and  more  fatal  than  those  of  the  south." 

Parrish^''  cjuotes  Davidson  and  Stntvcs  History  as  saying: 

"In  the  year  1797  a  colony  of  125  persons,  the  largest  which  had  yet  arrived, 
was  fatally  stricken  with  disease  at  New  Design,  (Monroe  County,  near  Burks- 
ville).  A  putrid  and  malignant  fever  broke  out  among  the  new  comers  attended 
by  such  fatality  as  to  sweep  one-half  of  them  into  the  grave  before  the  coming 
of  winter.     No  such  fatal  disease  ever  appeared  before  or  since  in  this  country." 

It  is  doubtful  whether  this  wa-.  scarlet  fe\'er.  In  the  quotation  pre- 
ceding this  one  scarlet  fever  is  called  "putrid  fever."  However,  the  term 
"putrid  fever"  is  generally  used  as  a  synonym  for  di])hlheria.  In  all  prob- 
ability this  fearfully  fatal  epidemic  was  either  diphtheria  or  scarlet  fever. 

1  Irdlicka*''  says,  "The  Indians  of  the  Southwest  now  have  very  little  scar- 
let fever.  However,  scarlet  fever  in  that  section  is  comiiaratively  rare  among 
the  whites."  It  seems  probable  that  scarlet  fever  was  found  at  times  among 
the  Indians  and  whites  in  the  French  regime. 


'  Zeuch,  Ibid. 
'  Drake,  Ibid. 
'  Parrish,  Ibid. 
=  Hrdlicka   (Uur 


ui   of  EthnoIoKy,   Bunetin   :!4,   lOOS). 


54  HISTORY  or  CKKTAIN  DISEASES  PIUOU  TO   ISTT 

In  tlu-  earl)-  ])art  of  this  (.■unltii-y  w  lu-n  ihe  otlier  stn-plncoccic  diseases, 
naiiK-ly,  erysipelas,  puerperal  fe\rr,  I'alal  siii)purati(ins  in  eumpcmnd  wounds, 
and  ]ierhaps  pneuinoiiia  and  meningitis  were  so  prevalent,  fatal  scarlet  fever 
niu^t  have  prevailed  extensively.  Even  fifty  years  ago  the  case  fatality  rate 
of  scarlet   fever  was  far  higher  than  it  is  liidaw 

Scarlet  fe\-er  is  found  re])orted  in  the  TraiiSdrlidiis  of  tlic  Illinois  Medi- 
cal Society  in  J.s.-)1,  1852,  185:,  1858,  18(iO,  IS(;!),  ls:o,  18-5,  18: G,  18:1  and 
1888. 

The  Decennial  Census  Reports  for  Illinois  for  J8(i(l  to  1880  show  the 
scarlet  fever  death  rates  as  follows: 

J  .SCO  ls:0  1880  1890 

US.:  85.1  44.4  11.5 

Rates  per  100,0(1(1  population. 

The  Chicago  Health  l)e]iartnient  Ke])orts  show  the  death  rates  from 
scarlet  fever  during  the  census  }ears  as  follows: 

1S51  ISdO  ]8:o  1880  1890 

50.  IM.T  !1!).,-,  g:.4  16.1 

Rates  per  1 00,000  pojjulation. 

Me.\sles. 

Drake""'  says:  "Measles  was  brought  in  by  the  immigra.nts.  It  af- 
fected white,  black  and  red  population  in  an  equal  degree.  The  people  of 
that  da\-  recognized  the  need  of  isolation  as  a  method  of  controlling  measles." 

-Measles  was  reimrted  ]iresent  in  the  State  in  the  Traiisaclioiis  of  the 
State  Medical  Society  for  1.S51,  l,s5-.\  l,s55,  l,s5:,  ISGH,  is:-?  and  ls;(;. 

Zeuch^^  refers  to  measles  as  being  epidemic  in  Hardin  County  in  1S18 
and  in  Henry  County    (Prophetstown)   in  1835. 

Measles  then,  as  now.  was  accepted  as  inevitable.  It  was  iirobably 
endemic  at  all  times  in  the  State,  though  it  was  only  repiorted  on  at  intervals. 
Probably  there  was  nothing  out  of  the  ordinary  for  the  reporter  to  say. 

The  following  statistics  show  the  trend  of  the  disease: 

Death  Ratic  Per  100,000  PoruLATioN. 

1851               1800               is:0               ISSO  1890 

Illinois (i.:i              •.':.(;               10.5  8.3 

Chicago   (L               PC:              ;!0.9              25.6  5.5 

"  Drake,   Ibid. 
•'  ZciHli.   n)ifl. 


HISTORY  OF  CERTAIN  DISEASES  PRIOR  TO  ISTT  55 

DlPHTHEKIA. 

Hirsch*^  thinks  the  honor  (if  first  describing  diplitheria  belongs  to 
"Areteus  the  forgotten"  one  of  the  distinguished  physicians  of  the  later 
Greek  period.  However,  he  credits  Bretonneau  with  naming  the  disease  and 
really  establishing  it,  in  1835.  However,  in  ]855  and  even  ninch  later  great 
confusion  prevailed  relative  to  it.  Hirsch  calls  attention  to  the  fact  that 
diphtheria  was  confounded  with  scarlet  fever  in  the  United  States  in  the  be- 
ginning of  the  Nineteenth  Century,  l^^lsewhere  attention  is  called  tn  the  pos- 
sibility that  epidemics  of  so-called  ])utrid  sore  throat  among  early  llliiKiis 
immigrants  mav  have  been  either  diphtheria  or  scarlet  tever. 

Hrdlicka  says  that  among  the  Indians  of  the  Southwest  epidemics  of 
diphtheria  have  been  known  to  prevail  at  times.  There  is  nothing  on  the  sub- 
ject in  the  literature  as  to  either  whites  or  Indians  in  the  French  Canadian 
regime.  In  the  Transactions  of  the  Illinois  Medical  Society  diphtheria  was 
late  in  making  its  appearance.  It  was  rejiorted  in  ls.")7.  lS(i(i.  iscl.  IsT'i. 
187G,  18T8. 

The  trend  of  the  disease  once  it  became  recognized  is  shown  ])\  the  fol- 
lowing mortality  rates  per  lOO.OOO: 

l.soo  1870  1880  181)0 

Illinois    :  0 . 0  ."lil .  0  1  v'".' .  M  93  . 


1870 

1880 

."lil.O 

Iv'-.MI 

.-.3.4 

184.S 

Chicago    UO.!)  .-.3.4  184.S  :-^.8 

Dr.  C.  H.  Johnson'-'  recounting  some  of  his  trying  experiences  with 
diphtheria  in  Central  Illinois  in  the  early  da\s  ijuotes  Henry  Ward  I'.eechei 
as  saying  "When  a  case  of  diphlheria  occurs  the  family  is  apt  lo  attribute 
it  to  a  visitation  of  Providence.  .\  dispensation  of  Providence!  W  hw  it 
is  nothing  in  the  world  but  rotten  cabbage  and  turnips  in  the  cellar!" 

Zeuclr'"  says  of  Kane  County;  "After  1856  diphtheria  di -place  1  ty- 
phoid fever.     Diphtheria  made  man\-  a  household  desolate." 

(.'VXANCHE. 

The  death  of  Ceneral  (jeorge  Washington  was  caused  b\'  cynanche  in 
the  opinion  of  the  physicians  in  attendance.  This  was  in  UIM).  l<"or  three 
quarters  of  a  century  thereafter  Washington  was  not  the  subject  of  i-rilical 
inquiry.  About  that  time  tlie  habit  of  inquiring  into  everything  and  r\er\- 
body  was  developed.  44un  tlu'  almost  sacred  traditions  and  myths  about 
Washington  came  under  the  microscope.     Somewhere  in  the  s;imc  gciiei'al 

"Hirscli,    UjuI. 
■"•Johnson,   U.iil. 
"■Zeueh,   Ibid. 


5()  IIIST()K^•  OK  CICKTAIN   DISICASES   PRIOR  TO   ]8TT 

period  bleeding  as  a  Ircatnirni  for  disease  having  lieen  aliandoned,  was  in  for 
some  condemnation,  'i'his  nuani  a  hattle  of  tiie  pros  and  cons.  The  cons 
alleged  among  other  things  that  (ieorge  Washington  had  1jeen  hied  to  death. 
This  opened  the  subject  of  Cjeorge  Washington's  last  illness,  l^jst  mortem 
and  (|uite  bi'latcd  diagnoses  of  di])btbcria.  pnruinmn.i  and  other  diseases 
were  m;ide. 

(  )ne  ri-a^on  for  the  inicertainl\'  un  the  nature  of  General  Washington's 
la.st  ilhu'ss  lay  ni  the  cause  of  death  as  gi\en  by  the  attending  ]jhysicians. 
It  was  CNiianche.  The  disputants  had  never  heard  of  cynanche.  They  could 
not  lind  it  in  the  books.  The  way  was  cleared  for  attributing  death  to  what- 
ever the  contenders  might  claim. 

In  ]r)2G,  Dr.  Waller  A.  Wells  of  Washington  reviewed  the  evidence  and 
proved  that  George  Washington  was  not  bled  to  death  nor  was  there  any 
kind  of  malpractice.  He  agreed  that  the  ex-President  did  not  die  from  diph- 
theria or  pneumonia.  His  death  resulted  from  an  inflammatory  oedema  of 
the  larvnx  due  to  some  unknown  infection  and  the  accepted  name  for  the  dis- 
order in  that  day  was  cynanche. 

Whether  the  name  cynanche  was  coined  b_\-  the  Edinburgh  School  of 
Medicine  or  not  does  not  a])pear,  but  the  great  medical  lights  of  that  city 
wrote  much  about  the  disorder  calling  it  cynanche.  Cynanche  might  be 
called  a  creation  of  h^dinburgh.  In  that  da)-  Edinburgh  was  the  fountain 
head  of  medical  lore.  Two  of  Washington's  three  physicians  were  ardent 
students  of  the  lMlinbtu"gh  school. 

The  diagnosis  of  cynanche  was  a  ])ro]:)cr  one  in  that  tlay.  There  are  a 
few  rei)orts  on  it  by  jjliysicians  of  the  upper  Mississippi  Valley  in  the  medi- 
cal journals  of  the  early  day. 

The  1S(;!)  Rcpoii  of  the  Chiciujo  Ilrallh  Jh-partuiciit  which  carried  vital 
statistics  by  causes  of  deaths  f(u-  each  year  after  IS.")  I,  contained  reports  of 
deaths  due  to  this  disease  yearly  from  IS.V^  to  lS(i7,  inclusive,  except  in  1X56 
and  ISti,-). 

Presumaldv  death  certificates  giving  cynanche  as  the  cause  of  death 
were  being  bled  elsewhere  in  the  State  as  late  as   ISi'i.j. 

It  nia\-  be  that  c\nanclie  has  ceased  to  trciuble  the  [leople  of  the  state,  or 
it  ni.av  be  th.at  the  disorder  still  exists  but  that  it  goes  by  other  names. 

Ali';.\i\(;iTis. 

Hirsch''  sa\s:  "1  he  e;niie^l  infurniatiim  mi  epidemic  meningitis  dates 
fidin   isii.'i  in  wliich  year  tlie  disease  was  prevalent  in  Geneva.  Switzerland." 

In  the  L'nitcd  ."^i.'ites  the  disease  ap|ieared  first  in  New  Hampshire  and 
Massachusetts  in  abotU    ISo;.      I!y    is  Hi   it   had   spreafl  td  the  western   and 

•••' Hir.sih   (Hamllxiiik  of  lludsraphic  and    1  li.stniical    l'atli.ilof;v,   vol.    III). 


HISTORY  OF  CERTAIN   DISEASES   PRIOR  TO   1877  57 

southern  States.  It  seemed  to  spread  from  centers.  That  first  epidemic  in 
the  United  States  came  to  an  end  in  about  1816. 

In  18-16  Gray  reported  an  epidemic  in  JeiTerson  County.  Illinois,  and 
elsewhere  in  southern  Illinois  occurring  in  LS45. 

Hirsch  says  that  from  1857  to  1871  the  United  States  was  again  the 
chief  seat  of  epidemic  meningitis.  Scarcely  a  year  passed  without  its  being 
seen  over  a  larger  or  a  smaller  area,  its  diffusion  from  first  to  last  covering 
the  whole  of  the  country. 

In  lS(i;!-()l  it  was  ei)i(lemic  in  the  southern  and  central  [larts  of  Illinois. 
Hirsch  quotes  from  Davis"'-'  and  AlcN'ey'''.  "I'.ut  in  the  winter  of  186.")  it 
broke  out  anew  in  various  parts  of  Illinciis.  In  1S72"'  it  was  epidemic  at 
Edwardsville,  Crawford  and  other  parts  of  Southern  Illinois." 

Hirsch  says  from  1805  to  1830  the  disease  was  in  isolated  epidemics  at 
various  places  in  Europe  but  was  more  general  in  the  United  States.  From 
1854  to  1875  the  malady  reached  its  widest  dilTusion  throughout  most  of 
Europe  and  the  L'nited  States.  In  Illinois  under  the  names  of  spotted  fever, 
meningeal  fever  and  meningitis,  cerebro-spinal  meningitis  prevailed  with 
considerable  frequency.  At  times  definite  epidemics  were  recognized. 
Oftentimes  meningitis  was  confused  with  other  diseases  in  spite  of  the  fact 
that  the  disease  loomed  large  in  the  minds  of  the  physicians  of  the  .State. 
It  is  referred  to  in  the  Reports  of  the  Coiinniltcc  on  Practical  Medicine  of 
the  State  Medical  Society  in  ls.")-i,  l.s."i5,  isiil,  ls70,  ISM,  LS^I,  ]S76  and 
1878.   . 

In  the  report  for  lS(il  Dr.  X.  S.  Davis  as  chairman  wrnte  "Those  epi- 
demic diseases  chiefly  worthy  of  mention  are  erysipelas  and  cerebro-spinal 
meningitis."  The  report  for  1873  said  "Meningeal  fever  rapidly  extended 
over  the  valley  of  the  Wabash." 

Zeuch's  Historv  of  the  Practice  of  Medicine  refers  to  an  epidemic  of 
it  in  Kane  Cnunty  in  1856. 

Epidemic  Oi'iitiialm  i a. 

In  183o-3G  according  to  Drake,  a  widespread  epidemic  of  oi)hthalmia 
prevailed  in  the  territory  in  which  Illinois  is  embraced,  l^rake  wrnte  "It 
would  be  interesting  to  discover  its  cause."  In  the  same  [laper  he  wrote 
"Neuralgias,  dyspepsia  and  chronic  hepatites  are  common." 

In  1861  in  the  Report  of  the  Conniiittee  on  Practical  Medicine,  N.  S. 
Davis  wrote  "iM-om  1S5-.'  in  |s.'i5  erisiiiel.-ilous  (j[ihthalmia  prevailed." 

The  references  to  ophllialniia  in  the  literature  of  the  period  were  many. 


==  Davis  (Transat-tion.s,   lU.  .\liil.  .Soc,   1SG7). 

»  McVey   (Transaeti()n.s,  111.  Med.  Soc,  1S67). 

"Southern    Illinois.      (Pliiladelphia    Med.    &    Surgical    llpts 


58  IllSTOKV  or  CICUTAIN  niSKASKS  I'UIOR  TO  1ST7 

W'l-  (if  this  (la\-  wciuhl  like  lu  broailcii  iIk'  ([uei')'  of  Drake  and  say  "It 
would  !)<-■  iiilcrrsliiiij  tu  Icani  what  was  tliis  oiilithahnia  which  so  plagued  the 
people  of  that   rnvly  day,   wliat  was  its  eatise  and   why   has  it  disajjpearcd." 

SvPIilLIS. 

The  venereal  diseases  were  recognized  as  of  puhlir  lu-alth  inipurtance 
in  the  earl\-  medical  history  of  Illinois  in  sjiile  nf  the  fact  Uiat  tin-  pupulatidu 
was  lari^cK-  rural.  The  'rraiisarliDiis  of  tltc  SUilc  Mftliral  Society  tor  the 
year  prinr  t(i  Isil  ccmtain  a  small  numliei"  nf  ]iapers  on  the  subject.  Some 
of  these  papers  prdpuM-d  laws  and  otln-r  connnuuity  actiim  fur  their  coutriil 
in  view  of  their  social  and  paUinlni^dc  inijmrtance.  However,  action  was  de- 
layed for  many  years. 

Syphilis  is  of  especial  interest  in  this  health  history  nf  Illinois  because 
the  early  settlers  w-ere  in  contact  with  the  Indians  for  a  long  time.  There  is 
a  wide  belief  that  syphilis  was  of  Indian  origin  and  that  the  Spanish  sailors  on 
the  expeditions  of  Columbus  contracted  the  disease  and  carried  it  to  Europe 
where  the}-  spread  it  somewhat.  Europe  according  to  this  theory  was  syplii- 
lized  bv  invading  armies  from  the  Mediterranean  district,  these  armies  hav- 
ing themselves  been  syphili/.ed  by  people  infected  by  Culumlius'  sailors.  The 
current  seems  miw  to  In-  running  away  from  that  theory.  The  present  trend 
of  opinion  is  thai  the  Eurcipeans  brought  syphilis  to  America  rather  than  that 
they  carried  it  in  the  other  direction.  Since  syphilis  had  a  tendency  to  cause 
bone  lesidMs  this  disease  lends  itself  unusually  well  to  speculation  of  this 
character. 

On  tins  pdini  llrdlicka'-''  says  :"Syphilis  exists  in  the  Indians  as  it  does 
in  the  whites,  therefore,  if  syphilis  existed  before  the  Spaniards  reached 
this  country  signs  of  it  should  be  at  least  occasionally  discovered  in  the  an- 
cient burials.  But  the  bones  of  the  old  burial  places  are  as  a  rule  free  from 
any  sign  of  the  disease  and  this  is  true  of  the  Ijones  from  ancient  graves  in 
California,  tlie  northwest  coast  and  other  localities  e.\clusive  of  some 
mounds.  It  is  diftieult  tn  see  if  the  disease  existed  before  the  whites  came, 
how,  with  the  well  known  wide  intercourse  among  the  ln<lians  wdiole  regions 
could  escape  it.  It  may  be  remarked  that  it  is  also  absent  in  the  older  burials 
in   Peru  and  olher  localities  in  South  .\merica." 

W  itli  this  Joseph  Jones'"'  who  investigated  the  skeletons  of  mound  build- 
ers in  the  (  )liio  \'alle\-  principally  in  Kentucky,  Tennessee  and  the  states  to 
the  norlh  of  the  ri\er,   does   not  agree. 

lie  fonml  esidence  of  sy|)hilis  in  the  bones  of  the  mound  builders. 
Based  on  lhi>  linding  he  t'xpressed  the  opinion  that  syphilis  was  one  of  the 

MHrdlifk.T    (.Icuirnal,   Am.   Jledical   Assn.,    Mar.    Id,    run;). 

M  Joseph  .tonus   (X.   ().    Ih-d.  &   Sni-Rical   .loiirnal,   .June,    1S7S). 


HISTORY  OF  CERTAIN  DISEASES  PRIOR  TO   1877  59 

pestilences  which  destroyed  vast  numbers  of  the  aborigines.  It  is  not  cer- 
tain from  the  reading  of  the  text  whether  he  meant  to  say  that  syi^hilis  among 
Indians  was  a  pestilence  pri(jr  to  the  Cdming  of  the  white  man.  liut  it  is  cer- 
tain that  he  was  sure  that  the  bones  he  examined  showed  that  the  mnund 
builders  had  syphilis  of  the  bones  prior  to  the  discovery  of  America.  His 
report  supported  the  Columbian  theory  of  the  origin  of  syphilis. 

Jose])h  Jones  was  an  able  scientist  and  a  learned  jiathologist  for  hi^  day 
but  he  could  easily  have  been  in  error.  It  will  be  recalled  that  at  one  time 
the  lione  lesions  found  in  the  l^gyjitian  mummies  were  thought  to  be  syphi- 
litic and  this  was  given  as  proof  that  the  Columbian  theory  was  wrong.  It 
was  not  until  a  very  capable  modern  British  pathologist,  Ruffier  examined 
these  Egyptian  mummies  that  it  was  proven  and  accepted  that  the  lesions 
were  not  syhilitic.  Probably  a  review  of  the  evidence  in  the  case  of  the 
mound  builder's  bones  might  lead  to  a  reversal  of  Joseph  Jones'  opinion  as 
it  did  in  the  case  of  the  Egyptian  speciinens. 

Dr.  Michel  Gandolphe''"  says  the  origin  of  sy])hilis  is  one  of  the  most 
controverted  points  in  medical  history.  The  epidemic  of  the  disease  which 
prevailed  so  widely  in  Europe  about  1900  acts  like  a  curtain  in  shutting  out 
all  the  history  of  syphilis  which  preceded  that  conflagration.  He  says  the 
research  in  the  literature  made  by  Notthaft  of  Munich  exhausted  all  the  pos- 
sible ties  of  solution  on  the  literary  side  and  came  to  no  conclusion.  There- 
fore, he  advocated  trying  tn  solve  it  b}'  study  of  the  bones  of  ancients. 

Lortel  found  what  he  thought  was  evidence  of  syphilis  in  the  skull  of 
an  Egyptian  nnmimy.  (iandolphe  examined  this  specimen  and  disagreed 
with  Lortel. 

But  in  1111  1  Raymond  sent  Gandolphe  two  bones  from  a  skeleton  found 
in  a  cave  in  the  .Marne  region  in  France.  These  bones  were  from  ]ieiiple 
who  lived  before  the  days  of  Christopher  Columbus,  (iandolphe  and  also 
Raymond  thought  these  bones  were  syphilitic. 

Whether  or  not  the  Indians  infected  the  whites  with  syphilis  originally, 
or  vice  versa,  it  is  nevertheless  true  that  this  disease  was  moderately  prev- 
alent among  the  whites  during  the  period  covered  by  this  history.  They 
doubtless  brought  some  of  the  infection  into  the  State  with  them.  The 
several  army  posts  located  in  the  area  nnist  have  contributed  to  its  spread. 
However,  the  great  majority  nf  the  people  were  males.  They  lived  isolated 
lives.     Syphilis  was  not  a  major  health  problem. 

Kramer  holds  that  the  Indians  had  syphilis  in  the  pre-Columbian  period. 
He  bases  his  opinion  on  the  relative  freedom  of  the  Indian  from  general 
paresis.  This  he  thinks  is  because  they  went  through  that  jihase  in  the  evo- 
lution of  the  disease  prior  to   1.')(|().     The   while   European   became   suliject 

"Gandolphe   (Lyon  Medicul,  Aug.   i,   1U1L>.      In-.    .Miclu-l    i  laminlplic ). 


60  HISTdin'  OF  Cr.KTAIN    DISEASES   PRIOR  TO    1877 

to  it  aluiut  loDii.  Al)()ui  i;i)()  lu-  lie,<,'an  tn  (k'velop  nerve  syi)liilis.  Since 
1IU)0  he  has  Ijeen  passinsj  mil  uf  tlir  .stai;x-  of  nerve  syphilis.  'The  black  man 
is  following  in  his  footsteps  about  two  huniired  years  bchinil  the  white  man 
just  as  the  red  man  preceded  him. 

There  are  many  accounts  of  the  presence  of  syphilis  and  other  venereal 
diseases  ainong  the  Indians  at  later  periods.  Ross  names  the  venereal  dis- 
eases as  being  among  the  more  common  com])laints  of  the  Indians  in  the 
eighteenth  and  nineteenth  century. 

Hrdlicka",  speaking  of  modern  Indians  says  "V'enereal  diseases,  while 
predominant  among  the  more  degraded  Indians,  are  more  or  less  effectually 
guarded  against  by  others.  The  Indians  tried  hard  to  prevent  the  whites 
from  infecting  their  people  with  venereal  diseases. 

I.  W.  Hunter''"  who  lived  a  captive  among  the  Indians  from  1796  to 
181(1  re])orts  "They  had  no  syphilis  until  they  contracted  it  from  the  whites." 
So  far  as  it  is  possible  to  conclude  from  so  little  evidence  the  conclusion  is 
that  syjjhilis  was  in  France  long  before  Columbus  sailed  from  America. 

GoXORPtHEA. 

Gonococcal  infections  are  supposed  to  be  far  older  than  syphilis.  They 
are  mentioned  in  the  Bible  in  several  places.  For  all  that  is  known  they  were 
present  in  Egypt  before  the  Hebrews  were  there.  \\'hen  these  infections 
came  into  Illinois  is  not  known,  nor  where.  Armies  of  some  sort  and  army 
posts  were  always  in  evidence  in  the  State.  There  were  French.  Spaniards 
and  British  to  iic  fought  and  the  Indians  were  a  constant  menace.  All  in 
all  there  were  enough  sources  of  infection. 

Fortunately  the  peojjle  were  hard-working  and  they  lived  in  rural  com- 
nnmities  in  the  main.  Gonococcal  infections  never  constituted  a  major 
health  prolilcm. 

("OXSI'MFTIOX    AND    (  )THEI{    FoKMS    Ob'    TuiiERCl'LOSIS. 

In  18  13  Daniel  Drake''"  wrote  "The  most  ]M'evalent  disease  of  the  In- 
dians is  scrofula.  It  almost  annihilated  the  Peorias."  His  description  of 
scrofula  shows  that  he  includes  tuberculosis  of  the  lungs  and  bones  with 
tuberculosis  of  the  glands  and  lungs.  lUit  this  oi)inion  was  not  the  general 
<ipinion.  It  may  ha\r  been  true  of  the  Peorias  as  Drake  Imd  heard  but  if  so 
it  was  for  some  s])rcial  reason.  Although  the  Indians  of  the  period  had 
tuberculosis  the  general  opinion  coincides  with  that  of  Hrdlicka  that  Indians 
living  under  primitive  conditions  are  not    wiped  out   b_\-   consumi)ti(in.      To 

'»Hi-<incka,   11. ill. 

'■"Hunter   (Nrw    Voik    .Mfd.   &    I'liy.siial   Journal.    JSS2,   1-174.      I.   \V.   Hunter). 

""nrako.  Tbid. 


HISTORY  OF  CERTAIN   DISEASES  PRIOR  TO   l.STT 


add  to  the  improbability  that  Drake's  opinion  held  for  all  Indians  the  physi- 
cians of  the  State  at  that  time  did  not  regard  consumption  as  very  prevalent 
among  patrons. 

In  IS-I  I  Drake  travelled  acros.s  tlie  State  to  St.  Louis  and  up  the  rivers 
to  Chicago  westward  to  Galena  and  south  down  the  river.  He  wrote  in  his 
journal  "The  physicians  from  Jacksonville  to  Joliet  tell  me  that  consumption 
is  one  of  the  rarest  diseases  in  Illinois."  He  recommended  that  the  State  be 
investigated  as  to  its  advantages  as  a  tuberculosis  resort.  x\s  late  as  1873 
Dr.  Harrison  Noble  included  in  his  Report  on  Practical  Medicine  to  the 
Medical  Society  this  statement  "I  have  never  seen  a  case  of  consumption 
in  Illinois  that  could  not  be  traced  to  Xew  England  soil." 

In  1859  Dr.  G.  W.  Phillips  of  Di.xon  wrote:  "It  is  a  fact  that  con- 
sumption is  rare  in  the  prairie  State  of  llhnnis." 

Gerhard^'  said  that  the  consum])tion  death  rate  in  Illinois  was  only  13G 
per  100,000.  That  rate  was  the  lowest  in  a  list  of  consum])tion  death  rates 
in  twelve  states  given  by  the  writer. 

The  only  references  to  consumption  found  in  the  Reports  of  the  Com- 
mittee on  Practical  Medicine  were  found  in  the  reports  of  1S52,  1.S55,  185'J, 
186!),  1873,  1874  and  1875. 

_  In  his  Report  on  Practical  Medicine  to  the 

.American  .Medical  Association  in  ISCiT,  Dr. 
R.  C.  Haniill  wrote  "The  opinion  is  entertaine<l 
by  some  of  the  oldest  practitioners  that  con- 
sumptives emigrating  from  the  New  England 
.States  have  found  length  of  days  by  residence 
in  our  ijroad  prairies".  But  he  did  not  accept 
their  opinion  for  he  wrote:  "Consumption 
heads  the  list  of  diseases  that  consign  to  early 
graves  the  youth  and  promise  of  tjur  Country." 
In  a  second  report  on  epidemics  in  Illinois 
made  to  the  same  association  in  l.s;o.  Dr. 
Hamill  ipiotes  Dr.  Haller  of  A'andalia  as  writ- 
ing "Pulmonary  consumption  is  increasing 
here  at  a  fearful  ratio.  Nearly  all  the  land  in 
the  count}'  is  drained".  There  were  man\-  who 
thought  malaria  due  indirectly  to  ])oor  drainage  protected  against  con- 
sumption. 

The  general  trend  of  these  references  was  that  the  disease  was  of  small 
consequence  in  the  State.  Occasional  articles  were  devoted  to  the  explana- 
tions of  and  reasons  for  the  comparatively  small  amount  of  consumjition  in 


It    Is.    IS 


K  As  11   Is;   its   llistiirv.   Cec.si-ipliv, 
Fri'deriek    Gerliarrt,    Cliicago,    lU.). 


6"2  IlISTOm'  OF  CKKTAIN   DISICASES  I'KIOK  TO    ISTT 

Jlliiicn\.     Tlu-  (Icalli   rates   fniin  ihc  disease  as  ^'iveii  l]y  the  Census   Office 

wiTe  per   10(1.(11)0  ]i(>piilali(iii : 

18,-)0                      J  SCO  18T0                      isso                      is'.iO 
114.5  145.0                  i:i|.-l                   14s.!( 

Tile  death  rates  in  Chicago  as  shown  hy  the  Cliicatjo  Health  }1cpar;incni 
Krf'ovt  were  : 

IS51  l,S(iO  1870  1880  IWiU 

123.5  25,2.8  i:(j.s  1G9.5  16:5.2 

The  figures  do  not  suhstantiate  the  opinions  of  the  pliysicians  of  the 
time.  It  is  not  necessary  to  discuss  the  reason  for  their  error.  It  is  enough 
to  say  tlie  error  is  a  common  one.  I-'.veryw-here  in  the  [leriod  when  the 
general  opinion  is  that  consumption  is  a  rare  disease  it  is  fnund  that  the 
deatli  rate  from  it  is  around  280  jier  100.000.  .Vs  attentinn  is  directed  to 
it.  the  consumption  deatli  rate  conimimly  declines.  The  limits  uf  this  de- 
chne  is  ahout  1  10  per  KJO.OOO. 

During  this  period  the  causes  indirectly  respimsilile  lor  the  decline  are 
certain  changes  in  customs  and  attitudes.  The  cases  are  recognized  and 
some  effort  is  made  to  prevent  them  from  sjireading  infection.  Careless- 
ness in  spitting  gives  way  to  some  degree  of  care.  Sleeping  with  consump- 
tives becomes  less  general.  Ventilation  is  im])roved.  Wages  go  U]).  Stand- 
ards of  living  are  raised,  food  is  more  abundant  and  of  lietter  quality.  Pro- 
found fatigue  is  less  general.  These  are  illustrations  of  the  kind  (if  change 
in  custom,  habit  and  attitude  which  reduces  the  consumptioit  death  rate 
from  about  280,  the  level  of  no  information  of  facts  nor  interest  in  them, 
to  about  140,  the  level  at  which  specific  work  against  the  disease  is  generally 
added  to  the  program.  These  added  features  called  specific  work  against 
the  disease,  consist  in  such  procedures  as  reporting  cases  of  the  disease,  build- 
ing and  operating  tuberculosis  hospitals,  sanitaria  and  dispensaries,  main- 
taining centers  and  nin^ses.  enforcing  sjiitting  regulations  and  other  nrdi- 
nances  and  laws. 

The  decline  in  this  period  of  systematic  control  is  from  about  1  10  to 
abnnt  ^0.  This  epuch  was  entered  in  Chicago  in  190^  and  in  the  remainder 
of  the  State  about  five  to  ten  years  later. 

PxKfMOXI.V   AND   Txi''H'EXZA. 

In  the  hisi(ir\  of  disease  in  llliniiis.  it  is  im])ossible  to  separate  the  pneu- 
monias from  intlueiiza  at  all  times  and  with  certainty.  The  former  were 
always  ])resenl  aii<l  ]irobalily  alwavs  will  be.  The  Indians  were  unquestion- 
ably subject  til  the  iJiieumonias  and   so   were  the  French-Canadian   settlers 


HISTORY  OF  CERTAIN   DISEASES  PRIOR  TO   1877  63 

during  their  regime.  In  the  earlier  writings  the  disease  was  uflen  called 
pleurisy.     Still  other  names  were  employed. 

Dr.  L.  C.  Taylor,  late  president  of  the  State  Board  of  Aledical  iCxamin- 
ers  and  of  the  State  Medical  Society,  was  accustomed  u<  lell  of  an  epidemic 
of  pneumonia  which  ])revaik'd  about  fifty  years  ago  near  Williamsyillc  in 
the  northern  end  of  Sangamon  County.  He  described  it  as  sweeping  as 
an  epidemic  wave  through  the  community  and  presenting  some  eyidence 
of  being  contagious.  It  was  his  opinion  that  the  disease  was  ordinary  en- 
demic ])neumonia  which  had  become  epidemic. 

Many  of  the  older  phy.sicians  were  of  the  opinion  that  (jrdinary  endemic 
pnetmionia  at  times  became  epidemic.  In  tlie  light  of  the  i)resent-d-i\-  opin- 
ion it  seems  probable  that  the  epidemic  wayes  rc])orted  in  the  literature  were 
really  epidemics  of  influenza.  On  this  account  no  sustained  effort  will  lie 
made  to  keep  the  diseases  separate. 

The  year  by  year  reports  as  foimd  in  the  Reports  of  tlic  Counnittcc  on 
Practical  Medicine  jirobably  refer  in  the  main  to  endemic  jmeumonia;  the 
reports  of  epidemics  refer  in  the  main  to  outbreaks  of  influenza. 

The  Transactions  of  the  society  for  the  following  years  contain  refer- 
ences to  pneumonia:  18.51,  18.52,  1855,  1857,  1858,  18G0,  ]8(;9,  1870,  1872, 
1874,  1875,  1878. 

Hirsch"-  says  that  the  year  1807  witnessed  a  great  pandemic  of  influenza. 
"In  October  of  that  year  it  was  in  the  Western  States  (that  is  the  upper 
Mississippi  and  the  Ohio  Valleys)  but  we  have  found  no  record  that  the 
sparse  population  of  the  Illinois  territory  suffered  from  it."  However,  they 
probably  did. 

In  1815-11)  it  was  again  pandemic.  It  was  generally  diftused  over  North 
America.  However,  there  are  no  specific  reports  of  it  in  the  Illinois  terri- 
tory. In  1833  Silas  Reed"-'  wrote  of  the  Western  Reserve  region  saying 
"Typhoid  pneumonia  prevailed  in  1813-14  in  the  Western  Reserve."  The 
probability  is  that  the  Illinois  territory  also  suiTered  from  it. 

In  1817  the  Medical  Repository  of  Original  Essays.  I'ol.  Ill,  ran  a  ser- 
ies of  fourteen  articles  from  eminent  clinicians  on  the  great  epidemic  of 
winter  pneumonia  which  ran  through  several  years  from  say  1812  to  1816. 
Of  the  fourteen  clinicians,  at  least  three  regarded  the  disease  as  influenza. 
The  clearest  thinking  in  this  series  of  papers  was  that  of  Dr.  Singleton  of  Vir- 
ginia. He  recognized  the  disease  as  influenza  and  referred  to  epidemics  of 
it  in  America  in  1733,  1775,  and  1770.  At  the  conclusion  of  his  paper  he 
propounded  the  inquiry  "Could  the  disease  have  been  brotight  to  this  country 
by  the  British  soldiers?" 

"'Hirsch,  Ibid. 

«2  Reed   (Western  JIeait-;il   &•  I'liy.sical   .Ihuii.-lI  ). 


G4  IIISTOln'   ()!■'   Cl'.kTAlX    DlSI'-ASl'lS    I'KKIK   TO    1877 

No  one  cm  read  llu-  ^yni])()siuni  willKJiu  CDiu-huliiin-  that  a  hiijli  gen- 
eral sickness  rate  went  with  the  epidemics  of  iiitlnen/a  and  |int'nniiinia.  (_'er- 
tain  of  the  sickness  and  nia\he  of  the  ejiidemics  were  cerebros]iinal  ineninL;itis, 
tlien  a  newly  descrilied  and  hnt  poorly  recognized  disease. 

C'aiil.  1.  n.  lulgar'''  says:  "In  December,  1.S12.  and  January  and  ■•'eh- 
rnar_\-,  I  s  I  ■">,  a  \ery  severe  and  fatal  epidemic  of  pneumonia  appeared  in 
both  the  arni\'  and  the  civilian  popnlatidn."  lie  refers  to  the  e]iideniic  at 
French  Mills  in  which  1 7  ])er  cent  nf  the  command  were  sick.  Of  the  sick 
52  per  cent  had  dysenterj',  24  per  cent  pneumonia,  8  per  cent  typhoid,  while 
IR  per  cent  had  ergot  paralysis  attributed  to  bread  made  from  flour  which 
contained  fundus  material. 

"An  epidemic  of  influenza  prev:iiled  in  Shawneelown  in  the  very  early 
days." 

Hirsch  says  influenza  was  again  in  pandemic  proportions  in  1824-26. 
It  was  generally  present  in  N'orth  .\nierica  and  was  reported  from  the  west. 
An  account  of  a  limited  eiiidemic  in  the  Wabash  \'alley  found  in  Drake's 
magazine""'  refers  to  a  part  of  this  epidemic.  In  1843  he  reported  another 
pandemic  in  North  .\merica.  In  this  ejiidemic  influenza  was  reported  from 
Illinois. 

Drake  wmte,  "Influenza  prevailed  in  1.S43  in  Xew  Orleans  and  St. 
l.ouis  and  in  all  the  intervening  towns." 

In  IS  I!)  a  report  on  pneumonia  in  Illinois  credited  the  gaseous  emana- 
tions from  the  school  stove  as  a  cause  of  the  prevailing  disorder.  The  the- 
ory that  carbon  monoxide  from  stoves  is  a  contributing  cause  of  pneumonia 
is  being  revived  today.  In  18."),")  Dr.  Crothers  of  Bloomington  reported  an 
epidemic  of  pneumonia  in  McLean  County.  Dr.  Spalding  reported  a  simi- 
lar epidemic  in  the  same  year  from  Galesburg. 

In  is."")?  Dr.  Thomas  Hall  of  Stark  County  wrote:  "Last  winter  Dr. 
Chamberlain  and  I  treated  7(i  cases  of  jineumonia." 

Dr.  C.  P>.  Johnson  of  Cham]iaign  writing  of  his  practice  in  Chatham, 
Sangamon  Coiint\-  about  ISCS  to  1S7(1,  s.aid  "During  the  two  and  a  half  years 
that  I  ])racticed  in  this  loeality  1  .saw  more  cases  of  pneumoni.a  (lung  fever) 
than  I  have  seen  in  many  3'ears  of  practice  since." 

Dr.  Forry,  the  Surgeon  General  of  the  Army,  and  Dr.  Cuolidge  gave  very 
good  accounts  of  epidemics  of  pneumonia  particularly  in  the  army,  in  the 
Nc7i-  York  Journal  of  Medicine  and  in  the  Army  Statistical  Reports. 

The  p.andemic  of  Is7-")  was  said  to  have  been  "univers.al  in  America." 
It  was  highly  fatal  in  Illinois.  It  was  peculiar  in  that  it  was  shortly  followed 
if  not  accompanied  by  a  jiandemic  of  epizootic  among  horses.  The  great 
])an(lemics  of  18S!l-'.il   and  r.tl8-2()  are  matters  of  more  recent  history. 

"'Edgar    (Jlilitary    SurRi-on,    Ifarc'li.    Itt27). 
"■'■Draltc   (WL-Ktcni   .M<<n.al  &  Pliysir.il   .roiirnal). 


HISTORY  OF  CERTAIN   DISEASES  PRIOR  TO   1877  65 

Some  statistics  as  to  the  prevalence  of  pneumonia  are  taken  from  the 
census  reports  for  Illinois  in  1850  and  1860,  1870  and  1880.  These  are 
presented  in  Tables  -1  to  8.  No  others  for  the  State  outside  of  Chicago  are 
available.  In  addition  there  are  given  in  Table  15  the  mortality  rates  for 
pneumonia  in  Chicago  from  1851  on.  In  these  figures  pneumonia,  broncho- 
pneumonia, bronchitis  and  influenza  are  combined. 

Puerperal  Fever. 

In  the  second  volume  of  Hirsch's  Handbook,  these  statements  are  found  : 
"Under  the  title  of  infective  traumatic  diseases  we  may  place  together  three 
nosological  forms — erysipelas,  puerperal  fever  and  hospital  gangrene  which  have 
this  much  in  common  that  they  bear  the  characteristics  of  an  infective  process 
and  are  in  their  origin  dependent  on  the  existence  of  some  breach  of  continuity 
in  the  external  or  internal  surfaces  of  the  body." 

He  (|U0tes  Leasure"''  as  saying  that  when  malignant  erysipelas  was  prev- 
alent in  New  Castle,  Pennsylvania,  in  1852  all  the  maternity  cases  in  his 
own  and  another  physician's  practice  got  puerperal  fever.  He  refers  to 
similar  rejjorts  by  Holsten,  Galbreith,  Ridley  and  other  American  ])ractition- 
ers  of  the  period  of  the  great  erysipelas  epidemic. 

The  discoveries  in  liacteriology  since  Hirsch  wrote  have  furnished  fur- 
ther proof  of  what  in  his  time  was  largely  speculation.  Hirsch  especially 
stresses  hospitals  in  the  history  of  ])Uerperal  fever,  saying  that  its  j)osition 
of  importance  was  not  assumed  until  the  development  of  ho^i)itals  and  hos- 
pitalization. 

Hirsch  quotes  Leasure'"  as  saying.  "In  this  c<iuntry  we  have  fortunately 
but  little  experience  of  the  alarmingly  fatal  epidemics  that  have  spread  their 
devastating  influence  over  different  sections  of  Great  Britain."  The  article 
bv  Hildreth'''"  elsewhere  referred  to  says,  "Puerperal  fevers  are  much  less 
common  than  in  more  populous  places." 

The  opportunities  for  the  spread  of  i)uerperal  fever  are  1)ellcr  in  hos- 
pitals, ])Ut  even  in  the  rural  districts  this  infection  has  always  found  a  way 
to  travel  from  household  to  household  and  from  patient  to  patient  at  times, 
while  some  of  it  is  due  to  the  presence  in  households  and  persons  of  the 
causative  bacteria.     A  parallel  is  seen  in  tetanus  infections. 

Some  of  the  aljove  quoted  literature  refers  to  puerperal  fever  and  even 
epidemics  of  it  in  rural  districts. 

The  reports  in  the  Transactions  of  the  Illinois  Aledic.al  Societ\-  make 
frequent  reference  to  the  prevalence  of  the  disease  in  the  rural  communi- 

™  Leasure   (American  Journal  Medical   Sciences,   1S56). 
"' Leasure   (American  Medical  Journal,  1835). 
«*Hilrtretli    < A iiieiii>;in  Jonrn.-il    Medical  Sciences,   1830). 


c,r, 


HISTORY  OF  CEUTAIX   DISEASES   PKIOR  TO   IS" 


ties  anil  tnwns  i:f  llic  Stale. 
Haull  tlir  cluiinnaii,  w  i-nU', 
variabl\-  fatal." 


In  the  Practical  Mcdiiinc  Rcf^ml  for  IsTi:;.  Dr. 
I'm-rjieral  fever  was  rife  and   1  tliinl<  it  was  in- 


In  Dr.  R.  I.  1  lannll's  Report  on  Prac- 
tical Medicine  made  to  the  Aniericati  MecUcal 
.Associatirm  there  is  an  account  of  an  e]M(leniic 
(if  j)uer])eral  fever  in  County  Hospital  which 
beijan  in  June.  Isds,  reported  by  Doctors  H. 
W.  j'ines  and  \\'.  E.  Ouine,  the  latter  an  in- 
terne was  later  President  of  the  State  Hoard 
of  Health.  Doctors  Jones  and  Ouine  clearly 
connected  the  prevalence  of  the  disease  with 
two  sources  of  infection. 

The  obstetrician  of  the   hospital   doubled 
as  pathologist  there.     He  alternated  jobs  be- 
tween   the    obstetric    wards    and   the   autopsy 
table.      The  internes,   students  and  physicians 
iM    K.ii.iTt  c.  Haniin.  were  allowed  to  exaiuine  jjarturient  women  al- 

most withnut  limitation. 
In  18  K).  Dr.  Oliver  Wendell  Holmes  wrote,  "The  disease  known  as 
puerperal  fever  is  so  far  contagious  as  to  be  frequentlv  carried  from  patient 
to  patient  by  physicians  and  nurses."  He  had  in  mind  childbed  fever  as  it 
was  ill  hospitals,  Ijut  there  is  proof  that  the  disease  was  sometimes  conveyed 
bv  persons  who  have  no  hospital  contacts. 

It  is  the  custom  now  to  say  that  there  is  no  decrease  in  the  mortality 
rate  from  puerperal  fever.  The  statement  may  be  true  when  the  present 
day  is  compared  with  say  twenty  to  tvventy-tive  years  ago.  But  it  is  not 
true  W'hen  the  present  day  is  comjiared  with  the  period  between  fifty  to  one 
hundred  years  ago. 

In  s]iite  of  the  distance  between  homes  and  the  almost  total  absence  of 
hospitals  for  maternity  cases  in  that  earlier  period  puerperal  fever  prevailed. 


Milk  Sioknes.'^. 

In  the  Report  an  Practical  Medicine  made  to  the  Illinois  Medical  Society 
in  1S.")1,  this  statement  is  found  "ll  seems  singular  that  a  disease  s])ceially 
lielonging  to  one  soil,  the  fear  of  which  has  turned  back  man\-  an  immigrant 
from  settling  in  our  State  should  ha\e  found  so  few  historians." 

.Milk  sickness,  while  not  spccialh'  belonging  to  the  soil  of  Illinois  was 
very  prevalent  in  the  State  in  the  early  days  and  may  have  prevented  many 
prospective  settlers  from  entering  or  remaining  in  the  State. 


HISTORY  OF  CERTAIN  DISEASES  PRIOR  TO   liSTT  07 

Drake  w  rote  of  milk  sickness  un(k'r  the  name  "Indian  trembles".  He 
says  "Hennei>in  first  wrote  of  the  trenililes  according  to  this  version.  The 
Indians  kiKiw  of  it  and  snlTered  from  il.  It  is  difficnlt  to  understand  how 
llie\-  could  have  esca|)e<l  il.  Thev  ma)-  not  have  had  any  cow's  milk  hul  they 
ate  the  flesh  of  animals  which  doubtless  suffered  from  'ireiiil lies'." 

.Drake  sa\s,  "To  escajK'  it  whole  communities  broke  up  liefore  they  had 
well  acquired  a  linn  footinsj.  Ahmy  fruitful  tracts  of  country  stood  long 
unoccupied  on  account  of  it." 

|ohn  Reynolds,  in  a  1 'ionecr  History  of  Illinois,  writing  of  conditions 
prior  to  ls:!:i.  said: 

"The  stock  of  Col.  Judy  was  injured  by  the  mysterious  disease  known  as  the 
milk  sickness.  It  made  its  appearance  in  early  times  in  his  stock  and  remains 
to  exist,  there  is  no  doubt.  The  human  family,  as  well  as  animals,  are  destroyed 
by  it.  I  had  a  sister  whose  death  it  was  supposed  was  caused  by  it.  It  is  known 
that  the  disease  is  a  poison.  Dogs  and  other  animals  die  with  the  poison  when 
they  eat  the  dead  bodies.  The  victims  of  this  disease,  the  human  beings  who  die 
by  the  disease,  derive  it  from  the  milk,  butter  or  meat  of  the  animal  infected  with 
the  poison.  The  name  of  the  disease  arises  from  the  milk  the  victims  eat.  This 
much  is  a.scertained;  but  what  is  the  poison  is  not  so  well  known.  It  is  the  general 
approved  opinion  that  the  poison  is  emited  from  some  poisonous  mineral  sub- 
stance in  the  earth.  It  rises  in  a  gaseous  state,  falls  back  on  the  vegetation,  is 
infused  in  the  water  and  in  the  morning  before  the  dew  is  evaporated  the  animals 
eat  the  poison  with  the  vegetation  and  thereby  die.  The  disease  only  appears 
in  the  fall  of  the  year  and  in  shady,  damp  localities.  A  vegetable  cannot 
cause  the  disease  because  it  would  have  been  discovered,  and  in  some  cases  animals 
that  are  kept  up  and  eat  no  green  food  die  by  the  use  of  the  water  impregnated 
with  the  poison.  It  makes  its  ravages  on  stock  in  many  parts  of  the  West.  Some- 
times for  many  years  it  almost  disappears  and  afterwards  returns  and  assumes 
its  former  virulence." 

Another  reason  other  than  its  prevalence  which  draws  attention  to  milk 
sickness  is  the  fact  that  a  number  of  people  connected  with  men  of  promi- 
nence died  of  it.  .Vmong  these  was  Nancy  Hanks  Lincoln  the  mother  of 
Abraham  Lincoln.  A  sister  of  Abraham  Lincoln  and  several  members  of 
the  Hanks  family  died  of  it.  It  caused  the  death  of  the  mother  of  (iovernor 
Chase  O.sborne  of  Michigan.  It  caused  the  deaths  of  several  members  of 
the  family  of  Dr.  A.  J.  Clay  who  for  many  years  was  a  local  health  officer 
of  Hoopeston.  Dr.  Clay  was  stimulated  by  his  family  and  personal  ex- 
periences to  sludv  the  cause  of  milk  sickness.  No  one  diil  more  than  he 
did  to  establish  the  fact  that  eating  while  snake  root  was  the  cause  of  the 
disorder. 

A  considerable  part  of  the  interest  in  milk  sickness  grew  out  of  the 
difticull\-  in  deciding  what  caused  it.  the  various  theories  about  it,  the  dis- 
cussicni  of  those  theories  and  a  certain  amount  of  myster)-  which  attached 
to  the  disease  and  its  cause. 

In  IS-U  Dr.  Daniel  Drake  wrote  that  the  first  good  descri])tion  of  the 
disease  was  that  of  Dr.  Thos.  Barbee  who  saw  it  in  Bourben  County,  Ohio, 
in  ISOO. 


G8  IllSTOUV  OF  CKKTAIN   DISKASES   PRIOR  TO    18TT 

In  l.s;!S  John  Rowe  a  farmer  announced  the  theory  that  milk  sickness  m 
animals  was  duf  to  their  havinsj  eaten  a  plant  eupatorinm  ageratoides. 
Soon  afterwards  Dr.  McGarragh  advocated  the  R<iwe  theory  before  the 
Highland  Medical  Society. 

In  Is  10  Dr.  Barbee  of  Marshall,  Edgar  County.  Illinois,  (possibly  a 
relative  nf  the  Thos.  Barbee  of  Ohio)  reported  several  cases  of  milk  sick- 
ness that  he  had  treated  in  Edgar  County  where  the  disease  was  very  preva- 
lent. He  gave  it  as  his  opinion  that  the  disease  was  caused  by  animals  eating 
a  plant  eurpatorium  ageratoides.  However,  instead  of  crediting  John  Rowe 
and  Dr.  McGarragh  with  the  discovery,  he  gave  the  credit  to  Dr.  Dale  Owen, 
state  geologist  of  Indiana.  Dr.  I'.arliee  says  Dr.  Owen  made  a  decoction 
from  the  plant  and  gave  it  to  a  calf,  causing  the  disease.  Dr.  Barbee  was 
of  the  opinion  that  milk  sickness  in  cattle  may  be  caused  by  their  eating  any 
one  of  several  plants.  Human  beings  were  poisoned  by  drinking  milk  or 
eating  meat  from  affected  animals. 

In  1S41  Dr.  Daniel  Drake  made  a  trip  to  the  vicinity  of  Washington, 
Ohio,  to  study  the  disease.  He  accejited  the  general  opiiiinn  of  the  day  that 
the  disease  was  related  in  some  way  to  the  type  of  soil,  the  trees  and  the 
[jlant  life.  His  reports  on  all  of  these  are  exhaustive  and  thorough.  He 
investigated  various  types  of  plants  including  eupatorium  and  rhus  and  came 
to  the  conclusion  that  milk  sickness  was  a  form  (if  food  poisoning  that  sev- 
eral plants  could  cause:  that  rhus  was  the  most  imiiortant,  that  many  dift'er- 
ent  animals  including  man,  cnws.  hog>.  dugs  and  liuzzards  cijuld  contract  it 
and  that  carnivemus  animals  such  as  men.  dogs  and  buzzards  got  it  from 
drinking  milk  or  eating  meat  from  poisoned  animals. 

It  was  not  until  very  recent  times  that  milk  sickness  in  Illinois  was 
proven  to  be  caused  by  animals  eating  white  snake  root.  Vnr  this  discovery 
Dr.  Clay  of  Hoopeston  was  largely  responsible.  Other  plants  can  cause  it 
and  in  other  sections  of  the  country  they  are  the  principal  cause  of  it.  Rowe 
and  other  farmers,  Barbee.  Drake,  McGarragh  and  other  physicians  were 
not  far  wrong  in  their  speculations  and  experiments  made  between  183S  and 
]s.'i,s.  Had  they  and  their  successors  stuck  to  their  lead  the  cause  of  the 
tniuble  shdiilfl  have  been  discovered  at  least  a  ([uarter  of  a  century  earlier 
than  it   was. 

The  fiilliiwing  quntations  are  from  Zeuch's  History  of  tin-  Practice  of 
.Medicine: 

"Even  as  late  as  1855  mucli  distress  was  created  by  tlie  appearance  of  milk 
sickness  near  Albion." 

"Dr.  Joseph  Gates  of  Marine  was  called  all  over  the  State  to  treat  milk  sick- 
ness which  had  an  extensive  prevalence.  This  was  in  1830  and  for  several  years 
thereafter." 

"Many  people  died  from  this  worse  than  the  plague."  (The  reference  was 
to   milk   sickness   in  Crawford   and   Clark   Counties.) 


HISTORY  OF  CERTAIN  DISEASES   PRIOR  TO   18T7  G9 

"The  milk  sickness  lay  in  wait  for  man  and  beast  along  nearly  all  streams 
throughout  the  county  and  often  proved  as  fatal  as  the  horrible  malarial."  ( This 
is  quoted  from  some  pioneer  as  being  descriptive  of  conditions  that  were  rather 
wide-spread  in  the  State.) 

"Milk  sickness  was  frequently  reported  from  Edgar  County." 

The  disease,  if  it  can  be  properly  called  such,  began  to  diminish  in  im- 
portance early  in  the  history  of  the  State.  In  1851  the  Report  an  Practical 
Medicine  contains  one  reference  to  milk  sickness.  That  of  1855,  devoted 
considerable  space  to  the  subject  and  quoted  a  fair  amount  of  literature  deal- 
ing with  it.  That  of  1858  discussed  milk  sickness  extensively.  After  1858 
it  was  seldom  alluded  to  at  meetings  of  the  State  Society.  Of  all  the  promi- 
nent diseases  of  the  early  days  of  Illinois  history  milk  sickness  was  one  of 
the  first  to  diminish  in  importance. 

Nursing  Sore  ^Iouth — (Possibly  Sltuvy). 

Somewhere  about  1856  a  peculiar  malady  prevailed.  It  was  called 
nursing  sore  mouth.  It  affected  mothers  who  were  nursing  babies  and  some 
of  the  reports  refer  to  nursing  babies  having  the  same  malady. 

Nursing  sore  mouth  is  found  covered  in  the  Practical  Medicine  Reports 
for  1857.  It  may  have  been  that  this  sore  mouth  was  scurvy.  In  1858  Eaily 
devoted  much  of  the  Report  on  Practical  Medicine  to  a  discussion  of  scurvy 
as  a  source  of  illness  in  Illinois.  Among  other  things  he  held  that  it  was  a 
factor  in  the  prevailing  sore  mouth  of  nursing  mothers. 

The  literature  does  not  record  the  acceptance  of  Dr.  Baily's  opinion  that 
scur^'y  underlay  many  of  the  ills  of  the  people  of  the  State.  Dr.  E.  P.  Cook 
of  Mendota,  in  an  earlier  Report  of  the  Committee  on  Practical  Medicine, 
had  referred  to  scurvv  as  being  in  part  respon>il:jle  for  the  continued  fevers 
of  the  period. 

Dr.  J.  H.  Hollister  reported  on  the  prevalence  of  nursing  sore  mouth 
in  Illinois  in  1859. 

Typhoid  Fever. 

The  travellers,  historians  and  other  lay  writers  who  wmte  incidentally 
or  otherwise  of  health  in  Illinois  in  the  first  half  of  the  nineteenth  century  or 
prior  thereto,  made  no  mention  of  typhoid  fever. 

The  medical  men  who  wrote  in  the  same  period  wrote  rather  frequently 
of  continued  fevers  of  one  sort  and  another  calling  them  by  different  names. 
When  they  began  to  refer  specifically  to  typhoid  fever  by  that  name,  about 
1S50  and  for  several  years  thereafter,  they  spoke  of  the  disease  as  having 
rather  definitely  in\aded  the  State  though  they  do  not  state  1)y  what  means 
nor  from  where. 


70  HISTORY  OF  CERTAIN   DISEASES  PRIOK  TO    IST? 

In  IS.jl,  Dr.  N.  S.  Davis  told  the  Chicago  Medical  Society:  "Typhoid 
fever  tirst  became  e])i(lemic  in  1848,  and  was  highly  fatal.  Since  then  it  has 
been  milder." 

In  ]S.")I),  Dr.  Roe  of  Hloomington  wrote:  "Typhoid  fever  is  now  first 
in  inipiirtance.  I'erhaps  not  even  cholera  exceeds  in  the  number  of  its  vic- 
tims this  fell  disease.  It  is  almost  as  yesterday  this  disease  made  its  first 
appearance  among  us." 

In  1851  the  Report  of  I  he  L'oiiuiiittrc  uii  Practical  Medicine  of  the  Illi- 
nois ]\Iedical  Society,  contained  this  statement:  "Much  has  lieen  written  on 
the  extension  westward  of  typhoid  fever." 

In  186:3,  Dr.  Noble  told  the  State  Medical  Society:  "Typhoid  first  came 
to  McLean  County  in  1846  and  1841." 

In  1864,  Dr.  J.  S.  Jewell  wrote:  "In  two  or  three  years  after  18.57 
the  continued  fevers  almo.st  entirel}'  supplanted  the  autiuunal  fevers." 

Dr.  J.  K.  Reeves"-'  gives  an  account  of  the  first  appearance  of  typhoid 
fever  in  \'irginia  in  184;3.  "It  seemed  to  have  suddenly  appeared  in  that 
year.     By  1X45  it  was  one  of  the  major  epidemic  diseases." 

I  think  it  is  a  f;iir  assumption  that  the  general  opinion  about  1S60  was 
that  Ivphoid  came  into  Illinois  .-ibout   1815. 

Htstorji  of  Steps  In   llic  Estdlilislinniil   of  Ti)i>Jiiiit!  Fcrer  as  a 

Specific  Disease. 

Physicians  everywhere  li:id  such  great  difficulty  in  recognizing  t)'phoid 
as  an  entity  that  it  is  interesting  td  trace  the  ste])s  by  which  this  disease 
emerged  from  the  fug  which  (il)scured  the  entire  field  in  the  first  quarter  of 
the  nineteenth  century. 

To  travel  this  path  properlv  it  will  be  necessary  to  begin  far  away  from 
Illinois  and  j)ri(ir  to  the  date  of  Illinois  statehood.  However,  the  place  of 
Illinois  physicians  in  the  world  wide  controversy  will  be  established  before 
the  story  has  been  cdmpleted. 

It  seems  pirdbable  that  typhoid  fever  has  always  existed,  though  the  dis- 
ease was  not  clearK  established  as  an  entity  until  the  study  by  Louis  ap- 
peared in  I  S3!). 

Dawson""  s;i_\-s :  "The  low  fevers  of  Hippocrates  and  (/ialen  may  have 
been  ty|)hoid." 

Dr.  C.  (i.  Cumston''  thinks  typhoid  fever  a  very  old  disease.  He  (juotes 
Thucydides'  description  of  a  fever  which  prevailed  in  the  Greek  army  in  the 
Peloponnesian  wars  and  gives  his  opinion  that  the  disease  was  typhoid.  He 
says:     "Petechial   fever — what  we  now  suppose  was  typhoid — ravished  the 


^^  Reeves   (Practical   Treatise  on  Enteric  Fever,   lS5it). 

'"Dawson   (Western  Medical  Medical  and  Physical  Journal,  1S44). 

•'Gumston   (N.  Y.  Medical  Journal  and  Record,  Feb.  16,   1927). 


HISTORY  OF  CERTAIN"   DISEASES  PRIOR  TO   1877  71 

island  of  Cyprus  at  the  end  of  the  fifteenth  century,  and  Italy  in  l.Vll  during 
the  expedition  of  Louis  XII  against  Naples.  Hence  it  appears  to  nie  that 
typhoid  fever  was  not  a  new  disease  ajipearing  at  the  end  of  the  15th  cen- 
tury." 

Murchison'-  says:  "Some  of  the  descriptions  of  the  Greek  writers 
I^robahly  referred  to  enteric  fever."  He  quotes  from  the  writings  of  Hip- 
pocrates and  ( ialen.  Spigelius  speaks  of  this  fever  as  comiuon  in  various 
jiarts  of  Italy.  With  this  statement,  however,  Hirsch'^  disagrees,  saying: 
"I  do  not  agree  with  Murchison  that  Spigelius  wrote  of  typhoid  fever  in  the 
17th  Century."  However,  Hirsch  says:  "In  the  writings  of  the  Hith  and 
17th  centuries  there  are  accounts  of  certain  forms  of  sickness  which  can 
hardly  be  interpreted  than  as  referring  to  typhoid." 

Among  those  who  wrote  of  what  Hirsch  said  was  typhoid  were  :  Syden- 
ham ( IGGl)  ;  Welles  (1682)  which  description  Hirsch  pronounces  "the  first 
clear  description  of  typhoid":  Lancise  (1718)  ;  Hoffman  (1728)  ;  Strothers 
(172!)):  Gilchrist  (1735);  Chirac  (1742);  Morgaginni  (1761)  and  Hux- 
ham  (1781). 

He  also  gives  a  large  numljcr  of  citations  from  the  French,  Genuan 
and  Italian,  all  of  which  show  that  a  considerable  amount  of  accurate  knowl- 
edge of  typhoid  fever  was  known  to  Europeans  prior  to  1800.  In  most 
instances  the  literature  cited  by  Murchison  is  the  same  as  that  cited  by  Hirsch. 

Bardett  says  that  the  first  good  description  of  the  pathology  of  typhoid 
fever  was  that  of  Prost  (1804).  Ahirchi>on  quotes  Prost  as  having  made 
])Ost  mortems  on  200  cases  of  typhoid. 

In  thi>  connection  the  year  1804  should  be  kejn  in  mind.  It  will  be 
referred  to  in  discussing  the  American  doctrine  of  the  unity  of  fevers  as  put 
forth  by  Benjamin  Rush. 

Hirsch  savs :  "Petit  and  Serres  (l.Ml)  gave  an  accurate  account  of 
typhoid  fever."  .Murchison  says  of  Petit  and  Serres  (1813)  :  "They  were 
the  first  to  regard  typhoid  as  specific." 

These  are  a  few  citations  of  tlic  literature  prior  to  that  of  182U.  In  that 
year  Louis  wrote  the  treatise  which  fixed  the  name  "typhoid"  and  secured 
general  recognition  of  the  disease  as  an  entity.  In  the  period  prior  to  182'J 
tv])hoid  was  frecjuently  confused,  es])ecially  with  tyi)hus.  Lois'  pupils, 
drawn  from  all  over  the  world,  returned  ti^  their  homes  carrying  the  teachings 
of  the  master. 

It  was  Gerhard  of  Philadi-lphia,  an  almost  yearly  visitor  to  European 
hospitals  during  this  period,  who  liroiiglu  b;ick  to  .\merica  definite  ideas  as 
to  typhoid  and  spread  them  over  the  country,  hut  particularly  along  the  At- 
lantic seaboard. 

■MClontinued  Fevers,   1.SG2). 

"Hirsch   (Handbook  of  Hist.  &  Geog.  P.ith..  ISSl). 


72  iiisTiiin  Hi-  I  i:rtai.\  diseases  pkiok  to  1ST? 

Subsf(|ia'iU  ti]  the  yt-ar  IS'ili  mcisi  of  ihc  coiilincntal  writers  of  ])romi- 
nence  raii.i,R'(l  iheniselves  lirhind  I.Duis.  (  )!i  the  (ither  hand  the  I'.ritish  were 
verv  iinieh  (Hs])i)se(l  to  huhl  that  ly]>lui>  ami  tyi)h(ii(l,  and  other  forms  of 
continued  fever,  were  due  to  the  same  yroup  of  causes.  'I'heir  scientists, 
Sydenham,  lluxjiam.  \\'elles,  Strothers  and  Erasmus  had  contrihuted  valu- 
able information  sustaining  the  position  ultimately  taken  by  I.ouis.  but  this 
they  seem  to  have  disregarded.  In  adopting  what  might  have  been  called 
the  British  doctrine  of  the  unity  of  fevers,  they  may  have  been  under  the 
influence  of  |)atriotism  growing  out  of  the  Xajioleonic  wars.     Who  knows? 

It  was  not  until  Sir  W.  jenner  wrote  in  ISH)  to  ls.")l  that  the  British 
tinallv  abandoned  this  position — the  doctrine  of  the  unity  of  fevers. 

In  1804  Benjamin  Rush  was  an  outstanding  figure  politically  and  in 
American  medicine.  He  had  signed  the  Declaration  of  Independence,  mean- 
ing American  independence  of  Great  Britain,  but  in  his  views  on  the  con- 
tinued fevers  he  was  anything  but  independent  of  British  contemporary 
opinion.  It  was  in  that  }ear.  or  ISO."),  that  he  wrote  his  views  on  fevers  as 
follows : 

"The  usurd  forms  of  the  disease  produced  by  the  miasmata  from  the 
sources  of  them  which  have  lieen  enumerated  are: 

1.  Malignant,  or  bilious  yellow  fever. 

2.  Inflammatory  bilious  fever. 

3.  Mild  remittent. 

4.  Mild  intermittent. 

5.  Chronic,  or  what  is  called  nervous  fever. 

6.  Febriculi. 

7.  Dysentery. 
S.  Colic. 

9.     Cholera  morbus. 
10.     Diarrhoea    (morbus)." 

Dr.  Ix-njaniin  Bush  had  just  passed  througli  a  great  epidemic  of  yellow 
fever  in  Philadelphia,  aiul  some  jian  of  this  opinion  was  founded  on  his 
experience  there  and  then.  P>ut  much  of  it  was  due  to  his  reading  of  British 
medical  literature.  Thereafter,  as  will  be  seen,  this  doctrine  became  known 
as  the  .American  doctrine  of  the  unity  of  fevers.  I'erhaps  one  statement  by 
Rush  in  the  pajier  quoted  is  enough  to  absolve  him  for  the  hann  he  did  by 
advocating  this  theory.  It  is:  'T  look  fin-  the  time  when  our  courts  of  law 
shall  punish  cities  and  \-illages  for  iiermitting  any  of  the  sources  of  bilious 
and  malignant   fevers  to  exist  within  their  jurisdiction." 

About  this  time  (1T0!I)  Xoali  XW'bster  contriljuted  to  the  same  grave 
error  of  a  common  meteorologic  and  miasmatic  origin  of  contagion  in  his 
otherwise  great  work.  "A  Brief  History  of  Epidemic  and  Pestilential  Dis- 
eases." 


HISTORY  OF  CERTAIN  DISEASES   PRIOR  TO   1877  73 

But  not  even  the  name  of  Webster  could  dis[)lace  that  i_if  Rush.  The 
(liictrine  of  the  unity  of  fevers  travelled  under  the  mantle  uf  fame  nf  Rush 
until  it  reached  the  Northwest  Territory  embracing  Illinois  and  the  contig- 
uous states.  In  the  East,  Nathan  Smith,  Jackson,  Gerhard  and  Hale,  and 
probably  Oliver  Wendell  Holmes  were  doing  their  best  to  spread  the  facts 
about  typhoid,  but  they  were  not  wholly  equal  to  the  task  of  overcoming  the 
influence  of  the  \iews  of  the  signer  of  the  ncclaratiim  of  Independence. 

J.  W.  Monette  uf  .Mississippi  attacked  the  ihenry  that  yellow  fever  was 
caused  Ijy  the  cause  uf  malaria  in  a  series  of  articles,  most  of  which  appeared 
in  the  jrrstcni  Mfilicul  and  Physical  Journal,  and  the  Aiiwricaii  Journal  of 
the  Medical  Sciences.  Dr.  Munette's  jiapers  were  masterpieces  and  left  Rush 
with  nnthing  to  stand  cm. 

In  these  earl\-  days  the  princijial  tliscussion  was  over  the  separateness 
of  typhus  and  typhnid.  In  1842  Bartlett  published  his  magnificent,  clear- 
cut  study  entitled  ".-/  llislory  of  Continued  Fevers".  After  that  the  opinion 
of  Rush  as  regards  the  oneness  of  typhus  and  typhoid  was  without  founda- 
tion. The  same  may  be  said  of  the  oneness  of  typhoid  and  malaria  though 
il  was  more  than  two  decades  before  the  notion  that  these  two  diseases  or 
groujis  of  diseases  were  related  some  way  or  other  came  to  an  end. 

.\nd  now.  let  us  move  from  the  Atlantic  seaboard  to  Ohio,  Indiana  and 
Illinois. 

The  (jutstanding  medical  man  of  influence  in  this  region  from  aliout 
ISl.')  to  about  IS.'id.  was  Daniel  Drake  of  Ohio.  lie  lectured  in  Cincinnati 
and  Lexington,  he  wrote  a  textbook,  he  conducted  the  first  medical  journal 
in  the  region,  and  he  carried  on  an  extensive  corresijondence  with  physicians 
in  all  parts  of  the  Mississippi  X'alley.  There  was  scarcely  a  section  that  he 
did  not  visit.     His  ac(|uainlance  was  wide  and  his  influence  was  great. 

Drake  was  very  much  under  the  influence  of  Rush.  Roth  he  and  his 
correspondents  believed  in  miasmata  and  telluric  influences  as  heaig  able  to 
cause  malaria  and  other  fevers,  perhaps  typhus.  He  showed  a  marked  ten- 
dency to  hold  that  the  typhoid  state,  or  a  fever  of  the  type  of  t\iihoid  could 
be  the  outcome  of  these  miasms. 

If  Drake  had  read  any  of  the  contributions  which  paved  the  way  for 
Louis  in  that  year,  there  is  no  evidence  that  they  changed  his  views:  nor  is 
it  certain  that  be  read  Louis  or  Gerhard  anywhere  soon  after  ls2!i. 

luniy  in  the  IlHh  century  the  ]ihysicians  of  the  U])i)er  Alississipjii  \alley 
seemed  to  have  accepted  the  opinion  that  the  slow  fever  in  that  region  was 
not  typhus.     After  about  1830  the  difficulty  in  this  region  on  this  question 


74  HISTORY  OF  CERTAIN  DISEASES  PRIOR  TO   18T7 

seemed  to  lie  liniilL-<l  tr)  difterentialing  between  the  low  fevers  caused  by  ma- 
laria and  those  caused  liy  typhoid. 

In  following;"  the  difticulties  in  distinguishing;  between  these  various  dis- 
eases at  this  time,  the  limitations  of  the  equipment  of  the  [ilixsicians  i.'f  the 
period,  must  be  taken  into  consideration.  rhe\'  hail  n(j  W'idal  examinations, 
no  bacteriologic  examinations  of  the  blood,  nci  microscopic  examinations  for 
malaria.  In  fact,  it  was  not  known  that  there  were  either  bacteria  or  plas- 
moilia.  I'hey  had  no  clinical  thermometers,  no  nurses,  no  hospitals,  and  no 
autopsies,  or  almost  none. 

There  were  no  medical  societies.  The  Aesculapian  Society  of  the  Wa- 
bash \'alley  was  not  established  until  1S4(J;  the  Illinois  Medical  Society  was 
not  organized  until  1S.")(I.  Fur  a  long  time  Drake's  journal  was  alone  in  the 
field.     Sending  jounials  through  the  mails  was  expensive. 

Oliver  Wendell  Holmes  once  wrote  to  Dr.  William  Osier:  'T  am 
pleased  to  remember  that  I  tfiok  my  ground  on  the  existing  evidence  before 
the  little  army  of  microbes  was  marched  up  to  support  my  contention."'  He 
had  reterence  to  his  article  on  the  contagiousness  of  puerperal  fever,  writ- 
ten in  isi;!,  Ijnt  the  men  whd  majiped  out  tvjjhoid  from  typhus  and  malaria 
could  ])ride  themselves  on  a  similar  accomiilishiuent. 

From  about  1S.">()  for  about  fortv  vears  the  nidst  intlueiuial  member  of 
the  Illinois  profession  was  Dr.  N.  S.  Davis.  In  18,")5  Dr.  C.  X.  Andrews  of 
Rockford  spoke  to  the  Illinois  Medical  Society  as  follows:  "Several 
articles  on  fever  w-ritten  by  Prof.  N.  S.  Davis  have  appeared  in  the  North- 
zvcstcni  Medical  and  Surgieal  JournaL  He  advocated  the  American  doctrine 
of  the  unity  of  fexers.  which  doctrine  I  regard  as  truthful  as  nature  itself. 
It  has  been  advanced  and  supjiorted  by  the  most  able  and  distinguished  of 
American  ]ihysiciaiis  and.  above  all.  Dr.  Benjamin  Rush." 

Flere  comes  this  doctrine  of  the  unity  of  fevers  again.  It  was  of  British 
ancestry.  Then  the  signer  of  the  Declaration  of  Independence  made  it 
American.  His  name  almost  became  a  part  of  its  name.  And.  at  last,  we 
find  it  here  in  the  Northwestern  Territor\-  aliuost  become  tlie  Illinois  doc- 
trine of  the  unity  of  fevers,  and  even  the  Davis  of  Illinois  doctrine  of  the 
unity  <;)f  fevers. 

Dr.  N.  .S.  Davis  said:  "I  do  not  think  that  all  tyjihoid  is  caused  l:)y  a 
specific  cause.     The  disease  can  lie  caused  bv  an\'  one  of  man\-  causes." 

In  a  discussion  of  fever  before  the  Illinois  Medical  .^ociet\-  in  is;  I,  Dr. 
Crawford  said:  "The  whole  famil\  of  the  coiuinued  fevers  are  from  the 
same  cause.     The  cause  is  miasmatic.'' 


HISTORY  OF  CERTAIN  DISEASES   PRIOR  TO   ISTI 


But  Dr.  Cook  of  Mendota  said  he  differed  from  Dr.  Crawford:  "We 
are  all  in  error  in  considering  these  fevers  as  a  unity.  1  have  seen  typhus 
fever  in  Ireland.     I  never  saw  a  case  here." 

In  IS-I-l  one  of  the  ablest  physi- 
cians in  llliniiis  moved  tn  Jacksonville, 
.Mnvi^an  Cdunty.  This  was  Dr.  David 
I'rince.  In  Xovember,  1846,  Dr.  F'rince 
read  a  jiaper  on  the  fevers  of  .Morgan 
Liiunty''.  He  named  four  kinds  uf 
malarial  fever  as  prevailing  in  that 
riJiintv.  The  third  of  the  series  of  four 
was  called  typhi lid  fever.  He  said  the 
icvers  of  one  tyjie  tend  to  run  into 
annther  type.  There  had  been  some 
change  in  the  fevers  of  Morgan  County 
since  is:5:.  Those  of  1837  to  1.S40  were 
more  sthenic  and  stood  bleeding  better. 
Those  of  1S41  to  1846  inclusive,  and 
especially  1S44  to  1846,  tended  to  be 
of  a  lower  type  with  more  tendency  to 
typhoid,  stood  bleeding  and  active  treat- 
Dr  i>ivi<i  Fiin.e  meut  Icss  wcU,  and  called  for  supportive 

treatment. 

Dr.  John  Wright  of  Clinton  said : 

"Typhoid  is  not  caused  by  the  same  cause  as 
ordinary  malarial  fever.  There  are  those  who  be- 
lieve they  have  one  common  origin  and  cause  but 
the  evidence  to  my  mind  is  not  convincing." 

In  the  report  on  the  diseases  of  Iowa  .'i 
Missouri  made  liy   Reyhurn'"'  this  statemein   is 
made : 

"The  terra  typhoid  is  used  (in  this  region)  to 
designate  an  autumnal  epidemic  fever  of  a  periodic 
type  which  is  ultimately  lost  in  the  continued  febrile 
movements.  An  exact  distinction  is  not  made  in 
this  part  of  the  country  between  those  different 
types  of  fever,  so  far  as  the  terms  used  to  designate 
are  concerned." 

The  authorities  which  have  been  quoted 
show  that  the  paper  by  Louis  was  a  consummation 
of  a  trend  of  opinion  that  had  been  forming  for 
some  time. 


'Prince,    (Illinois  and   Indiana   .Medical  and   Surgical   .lournal,   April.    1S47). 
iReyburn   (Trans.  A    .\I.  A..  ISoti). 


76  IIISIOKN'    OF   l-KKTAI\    DISi;,\SI-;S    I'NIOK    TO    ISTT 

Anders"''  says:  "Althnui^li  lyplioiil  fever  was  known  beyond  the  reach 
of  tracHtion,  it  was  not  nniil  isVli  that  typhnid  fever  was  clearly  distinguished 
from  typhus  fever The  decade  from  1S4()  to  IS.IO  witnessed  the  over- 
throw of  the  erroneous  n(]tii>ns  concerniniL;  the  similarity  of  tv]>hoid  and 
lyi)hus." 

In  ISlv!  I''.lisha  iiartlett's  wonderfully  clear  cut  text  on  fevers  a]3peared. 
While  an  eastern  \\(irk.  it  had  some  western  circulation,  and  it  made  the 
picture  clear.  After  it  appt'ared,  the  onlv  job  that  remained  was  to  get  the 
])hysicians  to  read,  observe  and  think. 

In  1843  Carroll""  reported  what  seemed  clearl\'  to  have  been  a  detinite 
outbreak  of  ejiidemic  tx'phoid  fe\er  in  I  .ane  Theological  Seminary.  Cin- 
cinnati. 

However,  the  old  Rush  influence,  i)articularly  as  regards  malaria  and 
tvphoid,  was  not  entirely  ready  to  die,  jiarticularly  in  Illinois  and  Indiana. 
The  great  leader  of  medical  opinion  in  Illinois  was  Dr.  N.  S.  Davis.  The 
yearly  transactions  of  the  Illinois  Medical  Society  show  that  he  was  a  be- 
liever in  the  theory  that  the  same  basic  cause,  moditied  one  way.  caused  ma- 
laria :  modified  another,  caused  typhoid. 

Cp  to  the  middle  of  the  decade  of  18.")()-]8(i0  this  was  the  prevailing  opin- 
ion of  the  physicians  of  the  State,  though  the  minority  who  thought  other- 
wise was  increasing  year  after  year.  By  I860  the  majority  seems  to  have 
swung  the  other  way.  Dr.  Davis  himself  changed  his  views  gradually, 
though  still  holding  to  some  part  of  his  basic  belief.  We  find  him  stating 
his  adherence  to  ^ome  part  of  tliis  basic  belief  as  late  as  the  year  1S';4.  Dr. 
Davis  said:  "1  do  not  think  that  all  tyjihoid  is  caused  by  a  sjiecitic  cause. 
The  disease  could  be  caused  liy  any  one  of  many  causes." 

In  the  'ryaiisaclioiis  we  find  him  reporting  cases  of  typhoid  in  the  fifties. 
In  ISCil  he  rep<n-te(l  having  treated  113  cases  of  "definite  ty])hoid  fever."  50 
in  his  private  ])ractice  and  (13  in  the  wards  of  nearliy  hospitals  in  the  previ- 
ous si.x  months. 

.\t  the  187  1  meeting  of  the  Illinois  Medical  Society.  13r.  b".  I'.  Cook  of 
Mendota  said:  "Typhoid  is  not  caused  by  the  same  cause  as  ordinary  ma- 
lai'ial  fe\er.  Tliere  are  those  who  lielie\'e  they  have  one  common  origin, 
and  that  one  can  be  converted  into  the  (jther.  lUu  the  arguments  have  never 
satisfied  me."  .\t  the  same  meeting.  Dr.  Crawford  said:  "The  whole 
family  of  the  continued  fevers  are  from  the  same  cause.  The  cause  is  mias- 
matic." 

In  18^"i  Dr.  Cook  again  reporting  for  the  Committee  on  Practical  Medi- 
cine, of  the  ."^tate  Medical  .Society,  said  that  typhoid  was  a  si)ecific  disease. 
He  predicted  "we  will  yet  find  a  specific  living  virus  for  t_\phoid  fever." 

■"Anders   (Piactui-  of   jre.li.iiuO. 

"C.irroll   (Wt-st.Tli  .Mt-di.:il  .iiid   l'liysi.-:il   .Imiiiuili. 


HISTORY  OF  CERTAIN   DISEASES  PRIOR  TO   18T7  77 

Some  of  the  physicians  of  Illinois  began  to  recognize  typhoid  fever  when 
they  saw  it  as  early  as  1845.  By  1850  the  number  of  these  men  able  to  diag- 
nose typhoid  in  spite  of  their  limited  equipment  was  fairly  large.  By  1860 
almost  every  physician  in  the  State  recognized  the  typical  cases  at  least.  How- 
ever when  the  possibility  of  malaria  was  great,  definite  diagnosis  was  diffi- 
cult or  impossible.  In  fact  it  was  not  until  the  Widal  test  for  typhoid  and 
the  microscopic  test  for  malaria  came  into  general  use  that  accurate  differen- 
tiation between  these  diseases  became  the  rule.  This  was  not  until  later  than 
1880.  The  confusion  in  the  minds  of  the  medical  profession  relative  to 
typhoid  and  malaria  was  the  result  of  several  factors.  In  the  first  place  it 
was  not  an  easy  matter  to  differentiate  the  one  from  the  other  prior  to  the  gen- 
eral use  of  laboratory  methods  although  the  popularization  of  the  clinical 
thermometer  was  a  great  aid. 

The  therapeutic  test  for  malaria,  namely  the  use  of  quinine,  was  of  great 
value  in  the  diagnosis  of  intermittent  fevers  but  these  were  not  confused  with 
typhoid  after  the  clinical  thermometer  came  into  use.  In  remittent  fevers 
and  particularly  in  the  more  continued  types  of  malaria  quinine  lost  much 
of  its  value  as  a  diagnostic  agent.  When  the  diagnostic  laboratory  pro- 
cedures came  into  general  use  this  factor  in  causjni;-  confusion  became  un- 
important. 

Other  factors  which  contributed  greatly  to  the  confusion  were  the 
various  speculations  as  to  the  relationship  between  the  diseases. 

One  of  these  speculations  was  that  typhoid  evolved  out  of  malaria. 
Some  believed  that  cases  started  in  as  malaria  and  ended  as  typhoid.  Some 
believed  that  typhoid  was  a  disease  evolved  out  of  malaria. 

Another  speculation  or  hypothesis  was  that  there  was  antagonism  be- 
tween the  two  diseases.  One  idea  was  that  the  antagonism  related  to  agents 
which  directly  caused  them,  the  other  was  that  it  related  to  the  environmental 
influences  which  indirectly  caused  them.  ,\nd  finally  there  was  a  theon- 
that  the  two  diseases  could  and  did  exist  simultaneously  in  the  same  patient 
each  influencing  the  other.  It  is  not  to  be  wondered  at;  that  under  the  in- 
fluence of  so  nnich  speculation  and  hypothesis  unchecked  by  procedures  for 
exact  determination  confusion  arose  and  continued  general  for  nearly  four 
decades. 

In  Bartlett'**  appears  this  statement :  "Typhoid  is  probablv  less  com- 
mon in  those  portions  of  the  U.  S.  which  are  visited  by  the  various  forms 
of  intermittent  and  remittent  fever,  though  further  observations  are  neces- 
sary to  settle  this  point."  The  view  that  there  was  some  antagonism  between 
these  diseases  was  rather  general,  even  as  late  as  the  middle  nineties  of  the 
last  century.     Physicians  were  reading  papers  in  medical  societies,  principally 

"Bartlett,  Ibid. 


78  lllSTOUV  OF  ri'.KTAIN   DISEASES   I'KIOR  TO    1STT 

in  the  southern  states,  denying  the  existence  of  typhoid  in  malarial  section ; 
as  late  as  1900.  No  longer  ago  than  1910,  there  was  discussion  in  the  medi- 
cal idurnals  nf  the  <(ucstion  whether  typhoid  exists  in  the  lro])ics.  It  took 
niuiiiir  W  idal  tr^is  and  the  routine  hlood  examination  to  cstahlish  the  ques- 
iIdu  in  IJK'  aHiinialiv  c. 

'Hk-  ihcnr\-  that  there  was  an  antagonism  hctw  ct-n  lyiihoid  and  malaria 
Hirsch  says  was  first  proposed  hy  Boudin.  In  ISK  the  Illinois  and  Indiana 
Medical  and  Surgical  Journal  quoted  an  article  by  Dr.  Boudin  from  the  Lan- 
cet of  lS4(i.  In  this.  Boudin  had  argued  there  was  an  antagonism  between 
typhoid  fever  and  malarial  fevers.  This  view  was  advocated  by  many 
authorities.  In  fact,  it  was  the  accepted  opinion  of  the  times.  .\ustin 
Flint'"  supported  it,  as  did  Daniel  Drake  in  the  same  year  and  for  many 
\x'ars.      Drake  showed  that  as  malaria  waned  t_\'i)hoid  increased. 

There  was  and  is  a  great  deal  of  o|)inion  to  the  effect  that  a  change  in 
enviroinnent  was  responsible  for  the  subsidence  of  malaria  and  the  develop- 
ment of  t\"].)hoid.  An  early  traveller  in  Illinois  wrote:  ".\>  the  country  was 
cleared  up  the  trees  were  cut  away  and  the  air  could  circulate,  malaria  less- 
ened and  typhoid  appeared." 

1.  .\.  I'.gair",  Secretary.  State  Board  of  Health,  Illinois,  said:  "The 
]ieople  of  the  early  day  were  compelled  to  meet  chills  and  fever,  cholera, 
smallpox  and  other  scourges  as  best  they  could.  .\t  first  there  were  the 
diseases  of  the  wilderness,  plasmodial  diseases,  cholera,  dysentery  and  other 
ailments  which  gradually  disappeared  with  the  cultivation  of  the  jirairies 
and  the  destruction  of  the  forests.  Rut  in  the  jjlace  of  these  came  the  sani- 
tarv  prolilems  of  denser  population." 

Hirsch  wrote:  "That  the  prominence  of  typhoid  as  malaria  wanes  is 
because  the  ]:)opulation  grows  crowded  in  proportion  as  the  sources  of  ma- 
laria disappeared  from  the  soil  by  drainage  and  cultivation."  There  is  no 
statement  that  better  expresses  the  relation  of  environment  to  the  two  dis- 
eases. 

The  theorv  that  t\i)hoi(l  grew  out  of  malaria  was  also  jiopular  toward 
the  middle  of  the  nineteenth  ceiuury. 

1  )r.  W.  L.  I'elder",  descriljed  a  fever  which  he  said  was  originally  iiUer- 
miltent  and  lapsed  into  tv|ihoid.  Mettaurer"-,  writing  of  the  fevers  of  \  ir- 
ginia,  lM(i  to  ISv!'.).  described  a  continued  fever  which  was  of  malarial  origin. 
Of  this  fever  there  were  three  varieties:  synochia,  or  ordinary  malaria, 
tyi)hoid  and  typhus. 

•"Flint    (HiilTalfi    .Medical    .Tcuiriial.    1S47.) 

»"  Eg-an   (Jlilitary  Tract  Medical   Society,   1906). 

»' Felder  (Trans.  A.  M.  A.,  1852). 

s^Mettauer  (Amer.  Jour.  Med.  Sc,  1S43). 


HISTORY  OF  CERTAIN   DISEASES  PRIOR  TO   187' 


79 


S.  H.  Dicksoir'  says:  "In  the  long  protracted  cases  of  ordinary  re- 
mittent fever  of  the  mahirious  region,  there  is  a  tendency  of  the  fever  to 
continuousness,  the  whole  ap])earance  is  I  hat  met  with  in  continued  fever — 
simple,  nervous  or  typhoid.  In  cnniniiin  ]ir(ifessii)nal  parlance,  such  cases 
take  nn  the  'typhoid  character.'  " 

W.  \\  Veatch**"*  wrote:  "In  Sangamon  County,  Illinois,  there  are  three 
classes  of  tviiho-malarial  fever,  tw"  nf  wliich  .are  i)rc:)lial)ly  malarial  and  one, 
tj'phoid." 

T jijilni-Malarial  Fever. 

It  was  in  \s',i\  that  Dr.  Woodward  of  the 
I'nited  States  .\rmy  read  a  paper  before  the 
Intern.-itional  Medical  Congress  on  the  subject 
of  iypho-malarial  fever.  This  paper  served 
to  fix  "t\']!ho-malarial  fever"  in  the  literature. 
It  also  served  to  precipitate  a  great  volume  of 
discussion  on  several  phases  of  both  the  ma- 
larial (juestion  and  the  typhoid  question.  The 
view  of  Dr.  Wdodward  met  with  a  mixed  re- 
ception from  the  .\rmy  Medical  Corps.  Ur. 
Charles  Smarl^'  says:  "Ilefi.re  the  introduc- 
tion of  the  term  the  .association  of  typhoid 
svmi)toms  with  malari.al  fever  and  of  malarial 
sym])toms  with  tvphoid  fever  was  well  recog- 
nized." 

If  it  he  contended  that  \\"oodward's  p;i])er 

was    a    piece    of    s]iecial    ])leading    for    typho- 

nialarial  fever,  it  can  lie  .answered  that  Smart's 

discussion  in  the  Medical  and  Siiri/ical  History  of  the  War  of  the  RcbcUioii 

is  special  pleading  against  it. 

\'aughan^''  says:  "Early  in  our  Ci\il  War  medical  officers  re|iorted 
fevers  which,  in  their  opini(jn.  diffcreil  from  typhoid  fever  as  seen  in  the 
north.  The  first  board  appointed  I  ISdl  i  to  investigate  the  matter  reported 
the  lever  prevalent  among  the  soldiers  was  bilioiis  remittent  fever  (malaria), 
which  not  having  been  controlled  in  its  primary  stage,  has  assumed  that 
adynamic  type  which  is  present  in  enteric  fever.  The  second  board  was 
convened  (  \S{;2  }  for  the  purpose  of  revising  the  sick  report.  Major  Wood- 
ward, the  chief  of  this  staff  insisted  that  the  prevailing  fevers  of  the  Armv 
of  the  Potomac  were  hvbricl  forms  resulting  from  the  combined  influences  of 


»  Dickson  (Trans.  A.  11.  A.,  1S52). 

"Veatch   (Chicago  Medical  Examiner,  1866). 

*»  Smart    (Medical  and  Surgical  History  of  tlie  W.ir  of  tlie 

""Vaughan    (Epidemiology  and  Public  Health,    V^r    in. 


80  HISTORY  OK  CKKTAIN   DISEASES  PRIOR  TO   187  T 

iiKiIarial  puisoniiii;  ami  the  causes  of  lyplmid  fever;  and  he  insisted  they 
should  be  reported  as  typlm-nialarial  fever.  This  designation  became  official 
July  1.  isr,-..',  and  fmni  that  lime  until  June  "-'It.  ISCG.  ."):,40()  cases  with  ."),;!60 
deaths  were  re]i(irled  under  this  name." 

Tin-  aclion   taken   by   the   Army    Hoard   in    ISli'^   under  the   influence  of 

\\" Iwanl.   ]ir(i(luced   a   great   amount   of    discussion,   scime   of   which   was 

acrimonious.  It  was  asserted  that  the  adoption  of  the  term  "typho-nialarial 
fever"'  was  a  recurrence  to  the  badly  discredited  and  well  nigh  abandoned 
doctrine  of  the  unity  of  fevers.  Some  said  it  provided  a  way  down  for 
some  men  of  eminence  who  had  allowed  themselves  to  become  stranded  on 
that  dead  limb,  the  unity  of  fevers.  It  is  said  that  there  is  a  way  out  for 
those  who  had  denied  the  existence  of  typhoid  fever.  Also  that  it  furnished 
a  new  wav  for  men  who  wanted  to  co\-er  uj)  antl  hide  the  ])revalence  of 
typhoid   fever  in  their   regions  and  connnunities. 

The  same  statement  was  made  in  the  reverse,  nanielw  that  the  term  was 
used  as  a  camouflage  for  malaria. 

It  was  said  that  its  use  led  to  sloppy  diagnoses,  lack  of  care  in  sanita- 
tion and  hygiene,  and  to  wrong  treatment  of  the  patient.  It  was  said  to  be 
unscientific,  as  well  as  incorrect. 

The  hre  and  heat  was  so  intense  that  the  term  fell  into  disuse.  To  this 
doubtless  the  decrease  in  malaria  contributed.  In  time  the  theory  that  there 
may  be  simultaneous  infection  with  a  bacillus  and  a  plasmodium  will  be  re- 
vived, though  there  may  never  be  a  great,  impelling  reason  for  reintroducing 
the  term  tvpho-malarial  fever  into  the  popular  vocabulary. 

There  is  no  reason  win'  an  individual  may  not  be  simultaneously  in- 
fected with  the  ])rotozo,an  of  malaria  and  the  bacillus  of  typhoid.  The  two 
organisms  can  exist  side  l)y  side  in  the  same  individual  either  with  active 
sym])toms  of  each,  or  with  one  or  both  latent,  or  in  the  latent  or  passive 
carrier  state. 

Dr.  C.  B.  lohnson"'  who  liegan  practice  in  Illinois  soon  after  isii."),  and 
who  has  practiced  widely  since  in  central  Illinois,  ex])resses  the  opinion 
which  was  aluKjst  universal  among  the  rank  and  file  of  practitioners  of  the 
period.  It  was  that  there  is  a  fever  which  should  he  called  (and  was  so- 
called)  typho-malarial  fever — "the  result  of  a  double  infection." 

Dr.  Breed  of  Princeton  held  that  t}])ho-malarial  fever  was  due  to  three 
causes  o])erating  simultaneously  in  the  same  ])atient.  These  were  the  cause 
of  malaria,  the  cause  of  ty]ihoid  and  the  cause  of  scurvy — typho-malarial 
fever  was  a  combination  of  typhoid  fe\er,  malarial  fever  and  scurvy — all 
three  of  these  diseases  abounded  in  Illinois  in  the  same  general  ])eriod  in  the 
early  day. 

<■■  Johii.son.  Ibid. 


HISTORY  OF  CERTAIN    DISEASES  PRIOR  TO    18TT  SI 

The  Transactions  of  tlic  Illinois  Medical  Society  for  18T.5  show  that  in 
that  year  typho-malarial  fever  was  both  attacked  and  defended.  Dr.  E.  P. 
Look  of  Mendota  said :  "1  think  there  is  no  donbt  Init  what  the  malarial 
poison  and  the  typhoid  fever  poison  can  and  do  affect  the  system  at  the  same 
time,  giving  typho-malarial  fever." 

F<i<)(l  P()is<iiiiii<i  as  (I  Source  of  Coiif nsmii. 

Some  confusion  as  relates  to  ty]ihiiid  has  always  existed  because  of 
speculation  as  to  some  forms  of  food  poisoning  as  a  cause  of  this  fever. 

A  knowledge  of  bacteriologj'  has  lent  something  to  the  confusion.  There 
are  cases  which  are  clinically  typhoid  but  which  do  not  give  the  serologic  or 
bacteriologic  tests  for  typhoid.    These  are  called  cases  of  para-typhoid. 

Recent  research  work  liy  Savage  and  White"*  tend  to  show  that  the 
tv])hoid  bacillus  is  a  member  of  the  great  Salmonella  family.  Some  of  the 
members  of  this  family  produce  food  poisoning,  some  typhoid  and  some 
other  disorders.  Largely  as  a  matter  of  speculation  they  suggest  that  the 
typhoid  bacillus  may  evolve  into  other  members  of  the  group  and  possibly 
that  tvphoid  lever  may  have  a  similar  relationship  to  food  poisoning  and 
the  allied  disorders. 

If  these  theories  are  correct  then  ty])hoi(l  may  have  evolved.  And  it 
may  have  done  so  in  Illinois.  In  fact,  it  may  have  done  so  in  181.")  and  it 
may  be  doing  so  now.  On  the  other  hand  typhoid  bacilli  may  be  evolving 
back  into  the  Salmonella  group,  to  |iroduce  food  poisoning,  or  even  harm- 
U>s  bacilli  right  now  and  every  day,  and  here. 

If  somewhere  between  one  and  three  per  cent  of  all  convalescents  from 
typhoid  become  chronic  carriers,  or  intermittent  carriers,  and  remain  so  for 
life,  what  becomes  of  all  the  carriers?  Why  are  thev  spreading  so  little 
typhoid?  If  ]iractically  the  entire  mature  population  of  thirty  years  ago 
h.id  had  typlKiid,  if  ninety-two  per  cent  of  those  who  had  the  disease  re- 
co\-ered.  and  'i  per  cent  of  those  became  chronic  carriers,  the  carrier  popu- 
lation of  the  country  must  have  nKJunted  to  more  than  a  milli(jn.  Why  is  it 
they  infected  so  few  people?  Could  their  typhoid  l)acilli  have  lost  the  spec- 
i;i]  (|ualities  of  the  bacillus  tyiihosus?  These  are  cjuestions  t(.)  which  there 
can  be  no  answer  now.  In  the  inyestigalion  of  ty[)hoid  among  troops  in 
the  Spanish-American  \\'ar,  the  tyi)lioid  commission  found,  among  other 
conclusions,  two  that  have  a  bearing  on  this  discussion. 

(  )ne  was  that  typhoid  was  often  inaugurated  by  a  diarrhoea  which  de- 
viloped  during  the  incubation  period  of  the  disease.  The  other  was  that  of 
the  troops  who  had  diarrhoea  some  weeks  prior  to  the  onset  of  the  e|)ideniic  of 
typhoid,  very  few  subsequently  developed  typhoid  and.  converseh',  ninety  jier 
cent  of  the  men  who  developed  typhoid  had  no  preceding  intestinal  disorder. 


'  SavaKe  and  White   (Briti.sli  Research  Council    l!i2i;  Spec-ial  Report.s  ill,   ;i2,   lO.'?). 


88  iiisrom-  oi--  ckktain  ihskases  prior  to  18T? 

'1  he  bru-lfrial  causu  df  ihcsc  diarrhoeas  was  not  (k-tL-nnincd.  Tlierefcire,  what 
they  .'-hiiw  either  fur  or  against  the  Savage  and  White  theory  is  purely  sjjec- 
iihiti\e. 

Coiiclii>;iaiis  as  hi  Tjiithanl  in  lUiiHiis  prior  lo   1S77. 

A  reasonable  interpretation  of  the  evidence  with  due  regard  to  what  is 
known  of  the  hahits  and  customs  (if  the  peciple  and  making  use  of  what  is 
nciw  known  ahunt  malaria  and  lyplmid  leads  t"  the  fcillowing  conclusions 
as  to  typhdid  fe\er  in   Illinois  jirior  to  liS^i  : 

1.  Txphiiid  was  hrouglu  to  Illinois  by  [leojile  who  were  carriers,  and  at 
times.  l)y  a  ty])ical  and  incubatory  case. 

•i.  In  the  earlv  days  the  sparsity  of  the  population  operated  against 
great  prevalence  of  the  disease. 

.'i.  Its  presence  was  obscured  liy  the  overwhelming  prevalence  of  ma- 
laria. 

4.  ?\luch  of  it  was  unrecognized  because  of  the  meagre  facilities  for 
diagnosis. 

■).  \\\t\\  the  increase  in  density  df  ])opulation  the  disease  became  more 
prevalent. 

(!.  With  the  decline  of  malaria  and  the  inipro\ement  in  the  methods  of 
diagnosis  recognition  became  easier  and  more  certain. 

T.  It  is  possible  that  some  typhoid  evolved  out  of  the  diarrhoeas  and 
food  poisonings  which  were  so  much  in  evidence  amimg  the  early  settlers. 
It  is  possible  that  such  evolutiun,  backwards  and  forwards,  is  going  on  all 
the  time  but  that  fact  is  not  proven.      It  is  purely  speculative. 

Increase  ill  T fijilidid . 

In  the  earlv  da\s.  according  to  all  autbcirities,  the  conditions  were  right 
for  the  increase  of  typhoid  once  it  found  entrance.  Flies  abounded;  water 
was  poor  and  frequently  polluted;  tuilet  facilities  were  meagre.  The  salva- 
tion of  the  people  was  then  isolation.  By  the  decade  lS10-lS."iO  there  was  a 
tendency  towards  the  building  of  cities. 

Railroads  were  being  built  and  canals  dug.  There  was  travel.  Some 
congestion  was  in  evidence  and  isolation  no  longer  ilominated  the  [)icture. 
Tyiihoid  fever  began  to  be  recognized  as  a  menace. 

Dr.  C.  B.  Johnson*"  said:  "In  most  instances  when  a  case  of  typhoid 
occurred  in  a  family  where  there  were  young  people,  all  would  be  apt  to  be- 
come infected  before  the  disease  had  spent  its  force." 

I'reraleiiee  iif  I'l/plioid  Fever  After  1S-'>0. 

The  earlier  decennial  reports  of  the  V.  S.  lUireau  of  Census  did  not  in- 
clude inortality  reports.      The  lir>i  u>  inclu<le  such  data  was  that  for  isr)0. 

''^  Jolinsoii,  n:ii<l. 


HISTORY  OF  CERTAIN.  DISEASES  PRIOR  TO   ISTT  83 

In  that  year,  according  to  the  census  report,  IlHnois  had  a  population 
of  851,470.  The  numlier  of  deaths  reported  as  due  to  typhoid  fever  was 
Gl.").     This  corresponded  to  a  rate  of  71. T  per  100,000. 

In  isilO  the  census  report  gave  the  number  of  deaths  in  Illinois  as  due 
to  typhoid  and  probable  typhoid  as  1188  or  a  rate  of  fjy.o  per  100,000.  In 
1870  as  1888  or  a  rate  of  75.5.  In  1880  in  Illinois  outside  Chicago  as  1187 
or  a  rate  of  1:9.5.  As  the  third  decade  of  the  "JOth  century  draws  to  a  close 
this  rate  is  close  to  4. 

Ti/pJioiil  Fever  in  CJiiear/ei. 

The  Chicago  record  began  in  1S5'2,  The  yearly  death  rates  per  lOO.OOO 
]i(ipulati(in  by  years  are  as  given  in  Table  l"i. 

The  record  is  so  inccunplete  that  deducing  from  it  is  risky.  .Vcknowl- 
edging  this  it  is  found  that  the  typhoid  rate  for  both  Illinois  and  Chicago 
about  lS.-)0-lS5v;  was  somewhere  about  70  to  100.  It  would  seem  that  even 
at  that  date  the  disease  was  so  widespread  as  to  suggest  that  it  had  been  in 
the  area  for  some  time.  Between  ISOO  and  1870  what  was  being  done  by 
the  communities  to  protect  themselves  against  typhoid  was  about  an  otifset 
to  the  natural  tendency  for  it  to  increase  as  population  increased.  The  coun- 
trv  outside  the  city  did  a  little  better  than  the  city  in  the  decade  1870-1879, 
though  a  portion  of  the  good  showing  of  the  countiT  is  more  apparent  than 
real. 

However,  neither  the  county  nor  the  city  was  making  well  considered 
effort  to  bring  the  disease  under  control. 

In  another  part  of  this  volume  is  shown  how  Chicago  liegan  its  master- 
ing fight  against  typhoid  soon  after  1890,  and  the  results  of  that  tight  and 
how  th^  State  followed  a  few  years  later,  and  how  it  in  turn  succeeded 
in  conquering  the  disease. 

.     - —       I)i.\RRHOEAS  AND  Dysenteries. 

There  is  no  fjuestion  but  that  diarrhoeas  and  dysenteries  were  ])ronii- 
nent  in  the  disease  history  of  Illinois.  The  writers  are  agreed  that  this  was 
true  of  the  Indian  regime.  Their  food  habits  and  their  water  supplies  both 
contributed  to  the  diarrhoea!  diseases.  They  affected  both  adults  and  children. 
The  same  was  true  of  the  French-Canadians,  during  their  regime.  Father 
Marquette  suffered  from  a  chronic  form  of  diarrhoea  and  finally  died  from 
it.  The  literature  of  the  period  makes  it  plain  that  diarrhoea  and  dysentery 
of  both  adults  and  children  were  prevaleiu. 

The  literature  of  the  .\merican  period  deals  largely  with  the  diarrhoeas 
and  dysenteries  of  adults.  All  information  is  that  the  death  rate  among 
babies  was  very  high.  The  importance  of  the  high  infant  mortality  rate 
came  to  be  recognized  very  early.     The  very  first  mortality  reports    from 


84  HISTOK'i'  OF  CERTAIN  DISEASES  PiUOR  TO   18T7 

Chicago  had  deaths  of  children  under  live  years  of  age  as  its  only  division 
except  that  by  months.  However,  the  physicians  of  the  period  did  not  sepa- 
rate of  diarrhoeas  of  children  under  separate  headings.  Their  reports  did 
not  analyze  this  heavy  child  death  rate  with  its  contributory  causes. 

Ditinlidrd  (iiiil  Di/sciitcr/i  in  Adults. 

The  Zcuch's  HisUiry  iif  the  Practice  of  iMcJiciiw  makes  the  following 
references : 

In  Union  County.  1S50.  There  was  "an  epidemic  of  diarrhoeal  diseases  wliich 
proved  fatal  to  many." 

In  Jo  Daviess  County.  1S27.  "An  epidemic  of  dysentery  prevailed  to  an 
alarming  extent.     Many  deaths  occurred." 

Dysentery  was  epidemic  in  Sangamon  County  and  Springfield.  1849. 

In  Stark  County  in  1840.     "Dysentery  of  a  very  fatal  type  prevailed." 

In  Kane  County.  "Dysentery  was  more  malignant  and  fatal  among  the  early 
settlers." 

In  the  Medical  and  Surgical  History  of  the  War  of  the  Rebellion  Wood- 
ward tabulates  and  analyzes  259,000  cases  of  acute  dysentery  and  diarrhoea 
and  28,000  cases  of  chronic  dysentery  and  diarrhoea  and  yet  in  the  two 
volumes  of  Drake's  Principal  Diseases  of  the  Interior  J 'alley  of  North 
America  (18:^0  and  18^4)  neither  dysentery  nor  diarrhoea  are  treated  except 
as  incidental  .symptoms  of  three  disorders. 

What  is  the  reason  for  these  apparent  cimtradictinns  ?  It  is  rather  easily 
unikM>t(iiid. 

Diarrhoea  and  dysentery  were  very  common  disorders.  In  most  cases 
they  were  treated  by  domestic  medicines  and  by  refraining  from  eating. 
When  a  physician  was  called  he  generally  treated  the  disorder  symptomat- 
ically.  Not  much  was  known  about  either  diarrhoea  or  dysentery.  Most 
cases  got  well  with  simple  treatment.  In  order  to  account  for  the  serious 
cases  the  doctor  fre([ucntly  attributed  the  disorder  to  some  other  malady. 
Malaria  was  the  generally  ascribed  cause.  In  IS.'i-^  Dr.  Thomas  Hall  of 
Toulon.  Stark  County  in  the  Report  of  the  Committee  on  Practical  Medicine 
said  physicians  all  acce]ited  the  view  that : 

"The  dvsenter\-  is  the  very  fever  itself,  with  the  particularity  that  it  is 
turned  inwards  up(in  the  intestines  and  discharges  itself  that  way."  Dr. 
Hall  was  correct.  Physicians  either  accejited  diarrhoea  and  dysenteries  as 
incidents  of  the  day's  work  and  gave  them  no  special  thought  or  else  they 
ascribed  them  to  malaria  and  wrote  of  what  they  regarded  as  the  basic  dis- 
ease. 

In  1S.")1  Dr.  Samuel  Thompson,  Chairman  of  the  Committee  on  Prac- 
tical Medicine,  Illinois  Medical  Society  exj^-esses  it  as  his  opinion  that  diar- 
rhoea, dysentery,  typhus  fever,  cholera  and  milk  sickness  were  modifications 
of  the  same  disease.     lUit   whatever  ma_\-  have  been  their  opinions  of  the 


IIISTOR'l'  OF  CFRTAIX   DISEASES  PRIOR  TO   187T  85 

cause,  from  time  to  time  the  malady  would  be  so  widespread  and  so  fatal 
that  the  physicians  writing  papers  would  mention  it  one  way  or  another. 

Dr.  S.  H.  Shoemaker  of  Columbia,  Monroe  County,  wrote  in  the  Si. 
Louis  Medical  Journal,  March.  iSfjo:  "Almost  every  physician  in  the  course 
of  his  practice  in  1848  and  18-1:!)  must  have  remarked  a  great  proclivit\-  in 
almost  every  disease  to  diarrhoea." 

In  185"i  Dr.  N.  S.  IJavis  in  the  Report  on  Practical  Medicine.  Illinois 
Medical  Society,  says  Dr.  S.  H.  Shoemaker  of  Columbia  reports  an  ei)idemic 
of  dysentery  of  a  very  severe  type  in  southern  Illinois.  Dr.  J.  T.  Stewart 
of  Peoria  wrote  Dr.  Davis.  "The  most  prevalent  disease  in  this  locality  was 
diarrhoea.  It  showed  a  tendency  tci  run  into  cholera."  Dr.  Thomas  Hall  of 
Stark  County  wrote.  "Early  in  August  diarrhdea  was  jirevalent  in  some  lo- 
calities.    C)n  September  !)th  dysentery  broke  out." 

In  IS."):;  Dr.  Thomas  Mall  of  Toulon  rc]iorted  to  the  State  Medical  So- 
ciety an  epidemic  of  d\senler\'  which  followed  one  of  diarrhoea  and  which 
was  followed  l.iy  an  ei)idemic  of  typhoid. 

In  185?.  Dr.  L'.  X.  Andrews  of  Rockford  reporting  for  the  Committee  on 
Practical  Medicine  told  of  an  epidemic  of  "spasmodic  cholera"  near  Rock- 
ford  in  September  and  October. 

In  1S5S  Dr.  V.  K.  Baily  of  Joliet  reporting  for  this  Committee  wrote 
of  an  eiiidemic  of  dysentery  in  his  practice.  He  described  one  case — a  ladv 
who  came  from  "a  place  where  a  severe  and  fatal  form  of  dysentery  ap- 
peared about  the  time  she  was  taken  sick." 

In  1S()()  Dr.  C.  ( loodbrake  of  Clinton,  Chairman  of  ihe  L'ommittee 
quoted  Dr.  R.  G.  McLaughlin  of  lleyworth  as  saying  (h'-enter\-  was  one  of 
the  most  ])revalcnt  diseases.  Dysenierv  ^vas  (|uite  prevalent  during  August 
and  September. 

Dr.  J.  W.  Coleman  of  LeRoy,  McLean  County,  reiiorteil  an  epidemic  of 
dysentery  which  ap]}eared  in  August.  "No  class,  age  or  sex  were  exempt. 
About  one  patient  died  out  of  each  fifteen  sick  but  five  miles  from  LeRoy  on 
the  Bioomington  road  twenty  cases  developed  of  whom  six  died." 

In  ]SU)  Dr.  W".  II.  \'eatch  reported  an  epidemic  of  dysentery  at  Rood- 
house,  Greene  County.  It  appeared  suddenly  July  1.  1S7  5,  and  lasted  sixty 
days.     There  were  300  cases  and  man}'  deaths.      b\'w  families  escaped. 

In  ISS'.l  I^r.  11.  \\.  Chapmrm  re|iorled  an  epidemic  of  dysentery  at  White 
Llall.  "It  started  in  June.  Iss'.i.  lly  the  middle  of  the  month  the  epidemic 
was  on.  It  lasted  until  llie  last  of  (  )ctobcr.  There  were  5'.1  deaths  from 
dysentery.      My  dealli  rate  was  1   in   11." 

in  discussing  Dr.  Ch.apman's  paper  Dr.  J.  1'.  .Matthews  of  C;irlinville 
said  he  had  seen  Xwo  such  ei)i(lemics.     One  was  near  Corinth.  Mississi]3pi, 


8G  HISTORY  OF  CERTAIN  DISEASES  PKIOR  TO  18?7 

ill  tliL'  army  in  lsi;:i.  The  other  was  in  Bird  eight  miles  west  of  Carhnville 
in  1  M.i  I.      In  that  epidemic  25  died  in  a  radius  of  five  miles. 

Dr.  \V.  J.  Chenoweth  reported  that  in  an  earlier  day  he  had  heen  in  a 
similar  epidemic  in  Decatur  in  which  one  tenth  of  the  ca.ses  died. 

Dr.  ^V.  L.  (ioodell  of  Effingham  reported  an  epidemic  between  1850  and 
18G()  in  which  he  saw  27  cases.  Dr.  Stahl  of  Grandville  said  fluxes  were 
very  prevalent  in  his  section.  Dr.  E.  P.  Cook  of  Mendota  reported  an  epi- 
demic in  which  he  had  served  in  1864. 

In  18(;;  Dr.  L.  T.  Hewins  of  Loda  (Coiiiiiiillrc  an  Practical  Medicine) 
reported  "Dysentery  in  an  epidemic  form  has  not  prevailed  in  the  eastern  and 
southern  parts  of  the  State  except  in  Edgar  County  and  some  parts  of  Coles 
County."  However,  Dr.  George  Ringland  reported  an  epidemic  that  year 
in  a  town  of  600  inhabitants.  The  first  case  appeared  June  2S  and  the  last 
in  September.     There  were  abovit  100  cases  and  13  deaths. 

Silas  Reed'"'  wrote  that  typhoid  dysenteries  were  especially  prevalent  in 
the  Western  Reserve  in  1824,  1826  and  1828.  In  those  years  Illinois  was 
drawing  heavily  on  the  Western  Reserve  for  accessions  to  its  population. 
The  annual  reports  of  the  Committee  on  Practical  Medicine  of  the  Illinois 
Medical  Societ\'  (there  were  years  in  which  no  reports  were  made)  contained 
reports  on  the  prevalence  of  diarrhoeas  and  dysenteries  in  1852,  1853,  1855, 
1857,  1858,  1860,  1867,  1869,  1872  and  1876.  Some  of  these  referred  to 
diarrhoea  in  children,  some  to  the  disease  in  adults.  Some  referred  to  epi- 
deiuics  of  diarrhoea  and  dysentery  tlmugh  in  most  of  them  the  disease  is  re- 
ported as  endemic. 

Infant  Mortality. 

(  Especiallv  that  due  tn  diarrhoeal  diseases.) 

Every  jierson  who  wrote  of  health  conditions  during  this  period  placed 
especial  stress  on  the  sickness  rate  and  esiiecially  on  the  diarrhcieal  disease 
rate  among  babies. 

If  there  was  confusion  as  to  the  causes  of  the  different  kinds  of  di- 
arrhoea among  adults  there  was  more  of  it  as  to  the  same  symptom  or  disease 
among  babies. 

Diarrhoea,  sumiuer  coni]ilaint,  cholera  morbus,  cholera  infantum  and 
dysentery  were  terms  used  more  or  less  interchangeal)ly. 

In  1858  Dr.  F.  K.  P)aily  of  Joliet  ]iroposed  that  the  term  cholera  in- 
faiuum  aiuericana  be  used  since  the  disease  was  so  prevalent  in  America. 
He  said  that  it  was  often  confounded  with  ordinary  diarrhoea.  He  said  one 
of  the  i|uestioiis  which  he  had  asked  related  to  cholera  infantum.  Nobody 
replied  to  that  (|Uestioii  \m{  he  knew  the  disease  was  prevalent  liccause  he  had 
seen  much  of  it  in  his  praciice  in  joliet  for  four  or  five  years. 

"'  Heed,  Uiiil. 


HISTORY  OF  CERTAIN  DISEASES  PRIOR  TO  ll^TT 


87 


III  1S71  Dr.  D.  W.  Young  of  Aurura  quoted  Dr.  A.  Jacobi  as  saying 
that  chiilt-ra  infantum  was  the  rcsuh  of  paralysis  of  the  nervous  system 
caused  by  heat. 

In  1.SS3  Dr.  L.  H.  Corr  of  Carlinville 
said  cholera  infantum  was  a  neurosis.  Many 
writers  thought  it  a  manifestation  of  malaria. 
Dr.  I.  Alurphy  uf  Peoria  told  of  his  success 
in  pre\-enting  it  by  giving  prophylactic  doses 
of  i|uinine  in  the  summer  time. 

In  IS.M  Dr.  C.  X.  .\ndrews  of  Rock  ford 
( Cdiiuiiittcc  (III  Practical  Medicine)  reported 
diarrhoea  and  cholera  mcirbus  were  also  s(.ime- 
what  prevalent  ])articularly  among  the  children. 
In  l.sriS  Dr.  Hiram  Mance  of  Lafayette 
wrote  "Cholera  infantum  prevails  every  sum- 
mer in  this  vicinity."  In  1859  Dr.  J.  O.  Harris 
of  Ottawa  wrote  "During  the  summer  months 
i,,.    |_    I,    ,.,,,. J.  diarrhoea  among  children  was  extremely  prev- 

alent." In  1S7  1  Dr.  O.  W.  Young  gave  this 
oi)inion :  "It  is  generally  conceded  that  mi)re  children  die  annually  from 
cholera  infantum  than  from  any  other  disease." 

In  is:'.)  Dr.  L.  H.  Corr  of  Carlinville  said  "Nearly  one  half  the  children 
born  die  before  reaching  5  years  of  age  and  nearly  one  half  of  these  deaths 
are  from  bow^el  troubles  commonly  called  cholera  infantum  or  summer  com- 
plaint." 

In  the  Transactions  of  the  State  Medical  Society  either  through  papers 
or  through  references  in  the  report  of  the  Committee  on  Practical  Medicine, 
cholera  infantum  was  covered  in  1858,  1860,  1869,  1871.  1876  and  1878. 

Diarrhoea  and  dysentery  usually  referring  to  these  diseases  in  children 
were  covered  in  1852,  1853,  1855,  1857,  1858,  1860,  1867,  1869,  l.s;v'  and 
is:  6. 

For  twenty-seven  years  1813  to  isii!)  inclusive  the  Cliicac/o  Health  De- 
partment Annual  Reports  carried  a  table  in  whicli  was  shown  the  total  num- 
ber of  deaths  at  all  ages  and  the  total  number  occurring  in  children  five  years 
of  age  and  younger.  Table  2  shows  the  percentages  of  the  total  deaths  in 
each  vear  which  were  in  children  as  aforesaid. 

Twice  in  the  period  the  number  of  deaths  of  children  was  less  than  :ln  per 
cent  of  the  whole.  Six  times  it  was  between  30  and  40  per  cent  of  the  whole. 
Six  times  between  40  and  50  per  cent.  Eleven  times  it  was  between  50  and  00 
per  cent.  Twice  it  was  over  60  per  cent.  It  seems  almost  inconceivable 
that  in  any  vear  the  deaths  of  young  children  should  nmre  th:in  eipial,  should 
even  a]j]3roximate  two  thirds  the  total  deaths  at  all  ages.     .\nd  yet  thai  h.-ij)- 


H,S  IIISTOUV  OF  CERTAIN-  DISEASES  PRIOR  TO   1877 

jK'iK'd  in  ("hicaj,'ii  and  ])rohalily  also  in  those  other  pcn'tions  of  the  State  in 
wliich  n(]  fecord  was  ke])t.  in  those  years  llie  total  <leath  rate  was  hiiijli. 
niakini^'  tlie  child  death   rale  ver\-  lii^h. 

In  Tlir  llishiry  of  the  I'mcticr  oj  Medicine  Zeuch  says:  "By  ISTS  the 
death  rate  from  infantile  diarrhoeas  had  fallen  to  one-fourlh  the  nninher 
in  1845." 

The  graphs  shown  in  Figures  I  to  i  showing  the  high  mortality  in  the 
summer  months  in  the  early  years  also  iioint  to  a  high  child  death  rate  in  that 
period.  The  great  ])art  of  the  death  rate  of  ])ahies  was  due  to  digestive  dis- 
orders. 

Deaths  of  Children  Under  Age  Five  in  Relation  to  Deaths  at 
All  Ages. 

In  view  of  the  fact  that  the  Chicago  vital  statistics  tahles  had  shown 
since  1SI">  the  relation  hetween  deaths  under  •">  and  all  deaths  Dr.  N.  S. 
Uavis  was  interested  in  that  suhject.  In  ls;:i  he  told  the  Illinois  Medical 
Societx'  that  in  Xorwa\-  the  deaths  of  children  under  live  years  of  age  were 
onlv  1  •'>  i)er  cent  of  the  total  deaths  ;  in  Alassachusetts  'ill  per  cent :  in  Bavaria 
."iD  per  cent.  It  would  he  interesting  to  know  whether  Illinois  was  in  the 
class  with  Norwa\-  or  with  that  of  kJavaria — or  was  somewhere  in  between, 
hi  all  prohabililv  it  was  nearer  liavaria  than  Norwa}  hut  there  is  no  way 
of  knowing  for  certain  since  Illinois  was  not  keeping  hooks  in  terms  of  vital 
statistics  at  that  time. 

But  Chicago  was  and  the  figures  are  available  for  coiuparison.  While 
the  death  rate  of  children  imder  -"i  years  of  age  down-state  was  not  quite 
equal  to  that  of  Chicago  the  difference  was  not  great.  Table  "2  shows  the 
[M-o])ortion  of  deaths  of  children  imder  five  years  of  age  to  total  deaths  in 
Chicago  from  lsi:i  to  isll  inclusive  and  for  purposes  of  comparison  the 
]jroportion  for  lii^o,  a  typical  \ear  in  the  present  period  is  also  shown.  This 
table  shows  that  Is;  I  had  the  worst  record  with  a  ]3ercentage  of  70.7.  In 
1873,  the  year  in  which  Dr.  Davis  made  the  slighting  reference  to  Bavaria,  the 
proportion  in  Chicago  was  •")!•. •'!.  in  Ba\-;iria  .")().  The  average  for  all  the 
years  l.sbl  to  1S7;  was  I'.i.l,  the  average  for  the  ten  \ears  1S(!-1:  to  187:!  in- 
clusive was  'il."!.  Compare  this  with  Chicago's  iiresenl  day  |iroiiortion  \' A 
and   Norway's    l-'i. 

In  I8;!i  Dr.  L.  II.  Corr  of  Carlinville  said  one  half  the  children  born 
ill  Illinois  died  bt'fore  reaching  five  )'ears  of  age. 

In  the  C.  S.  Registration  .\rea  in  r.iv'."i,  the  intmber  <d"  deaths 
aniony  children  under  live  \ears  of  age  per  100(1  total  deaths  was  187.0. 
The  number  in  ])ersons  over  five  years  of  age  was  812..').  or  a  ratio  of  ".^3 
jier  cent. 


HISTORY  OF  CERTAIN   DISEASES  PRIOR  TO   1877 


89 


Seasonal  Distribution  of  Disease. 

As  early  as  IcSfiT  there  were  plnsicians  who  I'nund  the  menace  of  respira- 
tory diseases  in  winter  ahnost  as  niucli  as  that  of  digestive  diseases  in  summer. 
In  LS67  Dr.  Haiiiill  told  the  American  Medical  Association  that  in  Illi- 
nois three-fifths  of  all  the  deaths    fnini  lung  diseases  occurred   in    March, 
.\|)ril  and  November.     The  least  murtality  occurred  in  July  and  August. 

'ra1)le  •')  and  Figures  1  to  7  show  the  radical  change  in  the  monthly  dis- 
trihutiun  of  disease  which  has  occurred  in  Chicago  since  1843.     It  is  reason- 

abl\'  certain  that  a  similar  change  has  occurred 

elsewhere  in  the  State  though  the  statistical 
data  to  establish  the  fact  are  not  available.  The 
figures  given  and  used  as  a  basis  for  the 
charts  are  ten-year  averages  and  therefore  tem- 
j)orarv  epidemic  influences  are  eliminated. 

'i'he  exceptions  to  the  statement  that  the 
figures  show  ten-year  averages  are  the  charts 
made  by  Dr.  Michael  Mannheinier  lor  Chicago 
in  18(;:  and  18(i8,  the  chart  for  ^'yi■^  and  the 
line  for  184;3-4lt.  The  charts  made  by  Dr. 
Mannheinier  are  included  because  they  show 
the  seasonal  distribution  of  fatalities  in  that 
day  and  alsn  because  they  were  pioneer  pro- 
Dr   .Mirhaei  Mannheimer  (luctiims   and   iif   superiiH'  excellence.      It   was 

nearly  thirtv  years  after  186!)  before  the  Chi- 
cago Health  Department  resumed  the  plan  of  charting  disease. 


1  able  V!. 
Ratio  df  Deaths  .\-Moxg  CiiiLDRirx    Less  Tii.\x   Fim-:  to  All   Deaths. 


1843  

1844  

28.5 

41.6 

1845  . 

40 

1846  

33.3 

1847  

1848  

37. 

41.6 

1849  

26.3 

1850   . 

36  7 

1851 

42  7 

1852 

33  9 

1853 

48  5 

1854  

...        32  9 

1855  

44  5 

1856  

52  7 

1857  

1858  

58.5 

57  3 

1859  

56  6 

1860  

55  7 

1861  

54.S 

Chicago  1843- is;;  axd  I'.i-.'." 

1862  

1863  

1864  

1865  

1866  

1867  

1868  

1869  

1570  

1571  

1872  

1873  

1574  

1575  

1S7«  

1877  


55. 

50.7 

51.4 

52.7 

48.8 

57.5 

42.2 

54.4 

62.8 

70.7 

45.2 

59.3 

61. 

61.2 

57. 

56.2 


90 


HISTORY  OK  CERTAIN  DISEASES  TRIOR  TO   18T7 


The  single  year  \'*'i'i  \^  i.liarted  as  a  sample  year  in  the  present  unex- 
pired decade.  The  chart  f(]r  the  forties  represents  an  incomplete  decade  he- 
cause  the  figures  for  1840-11  and  -12  arc  not  a\':iilahlc. 

The  charts  illustrate  total  deaths  rather  tlian  rales  and  in  consequence 
the  scale  has  had  to  he  changed.  In  order  to  i)revent  visual  misconception 
as  to  the  relative  summer  rise  in  isi:)  to  1841)  Fig.  7  is  inserted.  In  this 
chart  the  scale  is  different  from  that  used  for  1843-]S4ii  in  the  chart  shown 
in  Fig.  ;5. 

The  striking  features  disclosed  by  these  charts  are  the  summer  peaks  in 
the  earlier  charts  and  the  winter  peaks  in  the  later  one. 

The  summer  peak  which  was  the  outstanding  feature  of  the  sickness  rates 
prior  to  18S0  gradually  declined  thereafter.  Some  slight  tendency  to  decline 
was  noticed  several  years  before  1880  in  Chicago  where  the  health  depart- 
ment began  to  be  somewhat  efficient  in  the  latter  part  of  the  decade  1860-1869. 
By  1920  this  peak  had  wholly  disa]5peared.  The  disappearance  of  this  peak 
is  due  to  the  disappearance  of  malaria,  the  near  disappearance  of  typhoid  and 


Table  3. 
Average  Deaths  in  Chicago— 


■By  Months — Decades. 


Decade 

ending. 

Jan. 

Feb. 

Mar. 

Apr. 

Ma.v. 

.Iinie. 

.luly. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

1849* 

26 

27 

26.3 

27.1 

49.9 

42.6 

92 

80 

64 

44 

38 

29 

1859 

92.6 

84.4 

93.6 

95.6 

96.6 

117.9 

272.5 

386.7 

273.5 

156 

107.4 

102.2 

1869 

279.3 

263.9 

274.4 

253.8 

240.5 

224.9 

499.8 

583.3 

454.5 

405.3 

296.9 

302.4 

1915 

2938.6 

2836.2 

3158. 

2934. 

2803.7 

2362.4 

2527.5 

2686. 

2539.6 

2457.9 

2483.7 

2964.4 

1925 

3254.9 

3263.4 

3436.5 

3125.7 

2926.1 

2459.1 

2417.8 

2475.9 

2413.3 

3290.6 

2673.1 

3343.3 

*  7  years  only. 

the  great  decrease  in  the  diarrhoeal  diseases  and  other  causes  more  or  less 
related  to  the  work  of  health  departments  and  physicians.  The  winter  peak 
began  to  a|ipear  in  the  decade  1870-T9.  It  was  fairly  in  evidence  in  1880-89. 
Since  18!i()  it  has  been  the  striking  feature  of  the  picture.  Its  eminence  is 
in  ])art  due  to  the  recession  of  the  summer  peak.  However,  that  does  not 
tell  the  whole  story. 

During  a  part  of  the  time  the  sickness  rate  of  this  ])eak  period  has  been 
absolutel)-  higher  as  well  as  relatively  higher  than  it  was  during  the  pre- 
winter  ])eak  period.  The  contribution  of  the  pneiinioni.is  and  influenza  to 
this  result  has  been  elsewhere  discussed.  In  older  to  draw  conclusions  from 
statistics  of  the  acute  kniL;  infections  which  >hall  not  be  \ery  misleading  it 
is  necessary  to  combine  lobar  and  broncho  pneumonia,  bronchitis  and  endemic 
influenza  (either  actual  or  so-called).  It  m;iy  be  possible  to  separate  in- 
fluenza in  great  epidemic  years  without  radical  statistical  error  but  not  at 
other  times.  This  has  been  referred  to  in  the  section  dealing  with  pneumonia 
and  influenza. 


Sc«leof 
Noiitlily 
Morlalitv 


rar^irrjis^.iiraficryov.  v^::3o:  j^  ,:i::x::mt^\  Tzr^ax 


25?; 


9    « 


TTTTTill? 


0 

RAIN 

B.WI-ND 

W.WINE. 

ClUR  DAYS 

CLOUDY  DAYS 


nduAo 


FOLDOUT  BLANK 


THE  COURSE  OF  THE  TOTAL  MORTAIITYAND  THE  CHIEF  FATAL  DISEASES  IX  CHICAGO  FOR  18G«. 

(with  Mcl(H)rological  Observations  for  the  same  period  made  by  J.G.  LANGGUTH  JR  at  117  Randolph  St.) 
Prepared  by  M.MAXXHEIMER.M.  I),  under  the  direction  of  the  Registrar  of  Vital   Statistics. 


-lIumidity.Moisliireof  Atmosphrrc,(Foint  uf  Saluraliuii  100) 
'  liaroiiicter.WVi^t  or  Alniositiiere. 
■  "        -ofr 


-•  Uiicheat  and  Luweitt  Raniic  oi  Barometer. 


Thermometer.  Temperature  of  Atmosphere. 
Highe.st  and  Lowest  Rai^e  of  Thermometer. 


Fig.  2.   Second  Mannhelmer  chart. 


THE  C^OURSE  OF  THE  TOTAL  MORTALITY  AND  THE  CHIEF  FATAL  DISEASES  IN  CHICAGO  FOR  1867. 

(with  Mctooiological  Observations  for  tlie  same  period  made  by  J. G.  LAXGGUTH  JR  at  117  Randolph  St.) 
rrepared  by  M.:^L\XXHEI^^^:R.^^.D.  under- the  direction  of  the  Resistrar  of  Vital   Statistics. 


Fio.  1.    First  Mannheimer  chart. 


HISTORY  OF  CERTAIN  DISEASES  PRIOR  TO  ISTT 


91 


'-J_JI     1                 .       . 

""^ 

3 

^^ 

it'' 

£.                     **s 

L                      ^-^ 

cT                -                ^^0-" 

<' —                        ^^ 

hE              -^^ 

Et                         *>                     -        It 

^    — !-                       r     ■      ■        ■                 1 

Qj      1                                             ■  N^ 

c:        1                                                                               *  '                                                         1 

oi        ' 

"      It                                                                 ^^''          "- 

*     m               I              '5^ 

'  int             i             ^»«^ 

=--*■ 

'^                               ^<«* 

*t  di                 ^^ 

^s 

V                                   T 

X                    ^                                 m 

1  1 

"*.^                    -^ 

Z^ 

f 

^---' 

""  ■         "        ^    ^^"^ 

I    ^^-^ 

1             ^""s 

=                              "           ^*" 

4^ 

^s^ 

7 

O                                                                                                                                                                                                                                 '^                              _l 

1 

^^ 

^a" 

^t 

I      "■*»-•  = 

±                                         i                  *■»          T 

^           J.                                                               I          __ 

It                                             A 

z                                                                                                                      4^ 

)► 

-                     I              "        "       ""                                                                       '"^ 

i        i         _i                                                                                                                   1 

a                       1                                                                                                                                      _^ 

z                      1                                                                                                                                 ^ 

O             I                                                                   1                             _l_                                                                                ^' 

"                                                                                                                            *\^ 

<                                                                                                    '            ^^ 

>•!                                                                                                                                     f       _f*"-i» 

■°                                                            —L                                                                                                  "                                "'*t^V 

^                                                                                                                                   1? 

<                                                                                                                                                         t\ 

gl       1               _J                                                                                  1                          11 

u                       1                      1                  1              '  ^                                                1    J_ 

■>                    1                   1                11                            1                   111 

o  d 


92 


HISTORY  OF  CERTAIN  DISEASES  PRIOR  TO  1877 


Jan.    Feb.    Mar.    Apr.     Hay   June  July    Au^.  Sept.  Oct.    Nov.    Dec. 


Fui.  4.    Moiitlily  mortality  rates  in  Chicago  showing  the  change  fifty  years  have  wrought 
in  seasonal  distribution. 


HISTORY  OF  CERTAIN  DISEASES  PRIOR  TO   187 


93 


Chicago  (lortality  Rate  for  Acute   Respiratory 
Diseases  by  Decades 


27 
26 
25 
24 
23 
22 
21 
20 
19 
18 
17 
16 
15 


' \ 1 

J 


1870  1880  1690  1900  1910 

Fig.  5. 


94: 


IIISTOUV  OF  CEUTAIX  DISEASES  PRIOR  TO  1ST7 


30 
19 
Z8 
27 
26 
25 
24 
23 
22 
21 
20 
19 
18 
17 
16 
15 
14 
13 
12 


\ 

\ 

\ 

^"" 

\ 

1 

< 

\ 

\ 

\ 

\ 

\ 
\ 

\ 

« 

\ 

\ 

\ 

/^ 

o, 

/ 

/ 

\ 

/ 

\ 

V 

1 

\_ 

s 

N 

s 

1870 


1860 


1890 


1900 


1910 


Pig.  6.  Sliowing  tleceniiial  ninrtality  rates  frmii  all  causes  in 
Chicago  for  .Tamiary,  February  and  March  cuntrasted  with  that 
for  July.  August  and  September. 


IIISTORV  OF  CliKTAIN  DISEASES  PRIOR  TO  1877 


95 


Jan.     Feb.    Mar.     Apr.    May    June     July     Aug.   5epl.   Oct.    Nov.    Dec. 


Fig.  7.    Note  the  difference  in  seasonal  peaks.     The  autumnal  rise  in  the 
1916-1925  decade  was  due  to  the  influenza  pandemic  of  1918. 


96  HISTORY  OF  CEKTAIX  DISEASES   I'KIOK  TO   187? 

Bat  in  ackliliun  to  intiueiiza  and  tlie  pneumonias  the  winter  ])eak  is  made 
up  of  contributions  of  other  diseases  less  easily  related  to  respiratory  infec- 
tions. The  death  rates  from  smallpox,  measles,  scarlet  fever  and  diphtheria 
— all  important  diseases  of  the  winter  peak  period — h;ive  declined  without  any 
decided  or  certainly  without  a  pari  passu  decline  of  the  winter  peak.  Some 
of  the  few  health  students  who  have  studied  the  development  of  this  winter 
peak  ha\-e  attributed  it  to  the  great  influenza  wave  which  prevailed  in  Illinois 
during  a  peridd  which  began  about  December,  bS'.ill.  Iklt  the  tables  and  the 
charts  show  that  whatever  was  operating  to  change  bacteria  or  people  or  en- 
vironment or  several  of  these  combined  was  in  operation  prior  to  1890. 

The  solution  of  this  problem  is  bequeathed  to  the  Illinois  Department 
of  Public  Health  during  the  next  few  years.  The  solution  will  require  their 
best  thought.  It  will  require  research,  planning  and  strategy  because  it  is 
possible  that  the  people  may  need  to  change  many  of  their  social  methods 
and  customs  before  they  can  enjoy  good  health  and  low  death  rates  during 
the  winter  and  early  spring. 

Vital  Statistics  atid  Mortality  Rates  From  All  Causes. 

The  Seventh  Census,  that  of  lS."iO  was  the  first  to  give  anv  vital  sta- 
tistics and  what  it  gave  was  limited  to  ]>opulation  .gain,  tn  ])opulation  figures 
and  gross  death  and  liirth  rates. 

The  introduction   to   the   report   of   this  census   contains   the    following 

statements ; 

"The  tables  ot  the  census  which  undertake  to  give  the  total  number  of  births, 
marriages  and  deatlis  in  the  year  preceding  the  first  of  June,  1S50,  can  be  said  to 
have  very  little  value" — "Upon  the  subject  of  deaths  no  one  can  be  deceived  by 
the  figures  of  the  census  since  any  attempt  to  reason  from  them  would  demon- 
strate a  degree  of  vitality  and  healthfulness  of  the  United  States  unparallelled 
in  the  annals  of  mankind  and  would  overthrow  the  best  established  principles  of 
statisticians  and  contradict  all  science  and  experience.  The  truth  is  but  a  part 
ot  the  deaths  have  been  recorded  varying  for  sections  from  a  very  small  to  a 
very  large  part  of  the  whole" — "In  the  form  in  which  these  deaths  are  published 
they  are  of  no  value,  yet  in  the  opinion  ot  medical  gentlemen  in  different  parts 
of  the  Union  of  high  reputation  who  have  been  consulted  and  whose  testimony  is 
now  on  file  in  the  census  office  and  in  the  opinion  of  the  National  Medical  Conven- 
tion (American  Medical  Association)  who  are  equally  aware  of  the  precise  char- 
acter of  the  data,  the  publication  of  the  names  of  the  diseases  for  each  of  the 
counties  of  the  United  States,  the  period  ot  sickness,  the  age,  birth-place  and 
occupation  of  the  deceased,  the  exact  time  of  death,  defective  in  many  respects 
though  the  returns  maybe,  would  essentially  subserve  the  interests  of  the  medical 
profession  of  the  country  and  tend  to  the  promotion  of  public  health." 

'fhe  death  rate  as  given  l)y  this  census  for  Illinois  was  13. G — this  is  the 
death  rate  that  was  esteemed  impossible  because  it  "would  demonstrate  a 
degree  of  vitality  and  healthfulness  unparallelled  in  the  annals  of  mankind 
and  would  o\ertlirow  the  best  established  |)rinciples  of  statisticians  and 
contradict  all  science  and  experience."     'fhe  statement  was  true  in  I80O  but 


HISTORY  OF  CERTAIN   DISEASES  PRIOR  TO    ]ST7 


97 


by  i;ilu  the  death  rate  had  fallen  below  13. G  and  it  has  been  below  that  tigure 

every  year  since  except  in  the  influenza  epidemic  period.     What  was  thought 

to  be  impossible  in   1850   is   now   more  than   achieved   and   being   achieved 

is  accepted  as  a  matter  of  fact  and  alnmst  without  cumnu-nt  to  say  nothing 

of  praise. 

By  1860  most  of  the  standards  referred  to  in  the  introduction  t(3  the 

rejiort  in  the  Seventh  Census  had  Iteen  adopted.     Nevertheless,  the  actual 

returns   nf   death    were   far    from   satisfying  as   the   Sui)erintendent   of   the 

Seventh  Census  had  warned.     In  the  introduction  to  the  report  of  the  Eighth 

Census  are  found  the  following  statements : 

"It  is  manifest  that  neither  in  1S50  nor  in  ISSO  was  tlie  entire  mortality  of 
any  state  ascertained  and  reported  nor  was  even  such  an  approximation  obtained 
as  will  permit  any  reliable  calculation  to  be  made  of  the  rate  of  mortality.  The 
same  holds  true  of  the  deaths  reported  as  due  to  the  several  causes  of  death  such 
as  consumption." 

In  Tables  4  to  10  are  presented  some  excerpts  from  the  V.  S.  Census 
reports  of  1S,-)0-1,S80  relating  to  mortality  in  Illinois  and  the  population  of 
the  State. 

Table  4. 

Deaths  from  all  Causes  and  Certain  Diseases  in  Illinois — Decennial 
Years  1850-1880 — From  U.  S.  Census  Reports. 


Illinois. 

1850. 

1860. 

1870. 

1880. 

n,619 
13.6 

19.300 
11.2 

33,672 
13.2 

45.017 
14.6 

Doath  rates  under  1  yr.   per  I.OOO  births 

51.4 
87. 

4.1 
113.7 

128.8 

70. 

66.9 

6.3 
65.7 

41.2 

98.7 
.4 
22.3 
10.6 
I. 

50.3 

123.8 

1.2 
145.6 

188.3 

59. 
35.5 

43.4 

Bronchitis      1 

Pneumonia    .•.. 1 

168.2 

Influenza    1 

Pleiirisv     J 

0 
150.9 

148. 

Teething: 

Bowels,   disease   of 

122.9 

Mahiria    1 

36.1 

Remittent    

Tvphoid   anrl   Tvnhus 
Meninnifi'* 

70.3                 53.6 

CephiilitK                      

77.8 

85.1 
6.7 

Cerel.n.    -^imMl            

28.3 

Meiiir«in-                          

Enceilnllu.-                  

Scarlet   Fever   

44.4 

Smallpox     

i-'u 

10.5                 10.7 

Yellow    Fever    

Tvphus  Fever  

98 


IIISTOKV  OF  CEUTArX  DISEASES  PRIOR  TO   18T' 


Tabic  5. 

PorULATlON    AND   NuMBICR  OF   DeATHS ILLINOIS 

U.  S.  Census  Report  1850. 

Total  Population  851.470 

White    846,034 

Free  Colored   5.438 

Number  died  during  year 11.619 


Table  6. 

Number  of  Deaths  from  Certain  Diseases — Illinois 

U.  S.  Census  Report  1860. 

Population  1,711.951. 


Deaths   19,300 

Bowels,  disease  of 26 

Bronchitis    75 

Cephalitis   701 

Cholera     70 

Cholera  infantum   315 

Consumption    1,948 

Croup    1,158 

Diarrhoea    607 

Diphtheria    41 

Dysentery    845 

Enteritis    329 

Fever  intermittent   464 

Fever    remittent    tJS2 


Fever    typhoid    1,1  S3 

Infantile    373 

Influenza    14 

Measles    109 

Pleurisy 46 

Pneumonia    1,357 

Scarlet  fever    1,698 

Smallpox    S 

Teething    198 

Deaths  under  1  year 4.407 

Deaths  under  5  years •.  .  9.928 

Whooping    cough    3S2 

Yellow   fever    1 


Table  7. 

Number  of  Deaths  from  Certain  Causes — Illinois 

U.  S.  Census  Report  1870. 

Population  -i.S.-iO.SOI. 


Deaths  all  causes 33,672 

Cholera  infantum   1,869 

Croup    886 

Whooping    cough     640 

Measles  702 

Pneumonia   2. 882 

Smallpox     170 

Diphtheria    603 

Scarlet  fever    2,162 

Malaria    888 

Meningitis    43 

Typhoid    1,758 

Typhomalaria 17 


Typhus    131 

Meningitis    1.932 

Diarrhoea    1,284 

Dysentery    664 

Enteritis    603 

Bronchitis 219 

Under  1  year,  Total 9,215 

Under  1  year.  Females — 4,149 
Under  1  year.  Males     — 5,066 

Under  5  years.  Total 16.953 

Under  5  years,  Females — 7,836 
Under  5  years.   Males      — 9,117 


IIISTORV  OF  CERTAIN  DISEASES  PRIOR  TO   ISTT 


99 


Table   T — Continued. 
Illinois — 1S70 — Deaths. 


Disease. 

Male. 

Female. 

Total. 

2 
19 
12 
2 
139 
688 
472 
28 
131 

0 
13 
5 
3 
125 
522 
414 
12 
157 

2 

32 

Tvphonialarial      

17 

5 

264 

1210 

886 

40 

288 

Table  8. 

Number  of  Deaths  fro.m  Certain  Causes — Illinois  .\xd  Chicago 

U.  S.  Census  Report  1880. 

r'o])ulation  :!.07  ;,871. 


Number  deaths    45,017 

Bronchitis     709 

Cholera  infantum   1,884 

Cholera  morbus  169 

Consumption    4,645 

Diarrhoea     770 

Diphtheria    2,403 

Dysentery    698 

Enteritis    988 

Fever    77 

Meningitis 278 

Enteric  fever 1,652 

Malarial   fever    1.114 

Scarlet   fever    1,.369 


Typhus  fever   23 

Yellow  fever   5 

Whooping  cough   488 

Measles     603 

Meningitis    594 

Pneumonia    4,378 

Smallpox    45 

Erysipelas   334 

Yellow  fever,  group  2 2 

Yellow  fever,  group  3 3 

Bowels    Ill 

Croup    1.370 

Pleurisy    91 


Table  8 — Continued. 
Census — 1880 — Illinois. 


Living  1  yr.  of  age 87,859 

Death  per  1000  births  (males) . .  94.1 
Death  per  1000  births  (females)  75.8 
Total  deaths  under  1  yr 10,96S 


Deaths  under  5 19,667 

Percent  of  total  deaths  (males)  . .       44.8 
Percent  of  total  deaths  (females)       41.9 


Deaths — Ciiic.\(;o — Certain  Causes — Under  1  Ye." 


Per   1,000   births    (males) 166.7 

Per   1.000    births    (females) 122.4 

Total   under   1   year 3,533 


Under  5  years 5,871 

Percent  of  total  deaths  (males) . .      57.3 
Percent  of  total  deaths  (females)      54.8 


100 


IIISTORV  OF  CERTAIN  DISEASES  I'UIOR  TO   l.ST 


Table  9. 

Population'  ok  Illinois — Census  Years  Frdm  U.  S.  Census  Reports 
1810-1888. 


Population. 

],K,ease. 

Year. 

Per  cent. 

Numeriial. 

U,282 

85.211 

155,455 

476.183 

851,470 

1,711,951 

2,539,891 

3,077.871 

349,52 
185.16 
202.44 
78.81 
112.8 
48.36 
21.18 

32,929 

1830 

100,244 

1840 

1850 

1860 

320.72S 
375.287 
860.481 
827,940 

537,980 

Table  10. 

Increase  of  I'oI'ulation  by  Census  Years  From  U.  S.  Census  Reports 
1810-18.511. 


Year. 

Whites. 

Increase. 

Free 
Colored. 

Int-rease.          Slaves. 

Increase. 

Total. 

Percent. 

613 

457 

1,637 

3,598 

5,436 

12,282 
55,211 
155.445 
476,183 
851,470 

1820               53,788 
1830             155,061 
1840             472,254 
1850              846.034 

367.68 
188.28 
204.56 
79.14 

20.44  1  917 
258.2  i  747 
119.79                331 

57.08       

445.83 
18.53* 
55.68* 

349.52 
185.16 
202.44 
78.  SI 

HEALTH  HISTORY  PRIOR  TO  1877  OF  SOME  OF  THE 
CITIES,  IN  ILLINOIS. 

Chicago. 

In  a  health  history  of  Illinois,  Chicago  anil  the  Chicago  area  deserves 
especial  consideration.  It  was  the  portal  of  entry  for  that  great  part  of  the 
population  which  now  dominates  the  State  ancl  which  has  been  prominent  in 
the  State  since  1840  at  least.  They  or  their  parents  or  grandparents  en- 
tered Illinois  at  Chicago  and  remained  there  or  somewhere  else  north  of  the 
center  of  the  State.  This  population  has  been  a  health  factor  differing  some- 
what from  that  of  other  parts  of  the  State. 

Chicago  is  the  largest  center  of  population  in  the  State.  It  had  a  health 
department  many  years  before  the  State  organized  one  and  this  example 
helped  the  medical  profession  to  get  a  state  health  department.  At  times  it 
has  contributed  diseases  to  other  parts  of  the  State  and  at  times  other  parts 
of  the  State  have  contributed  disease  to  Chicago. 

The  great  Irish  wave  of  immigration  of  the  thirties  and  forties,  the  great 
German  wave  of  a  little  later  period,  the  great  Scandinavian  wave  of  the 
seventies  and  the  lesser  immigration  waves  from  other  lands,  all  these  great 
masses  of  people  influenced  the  health  of  the  population  among  whom  they 
settled. 

The  immigration  into  the  State  from  other  states  which  came  through 
this  portal,  speaking  in  a  general  way.  came  from  diiYerent  states  than  that 
which  settled  in  the  prairies  and  to  the  south  thereof. 

The  great  aggregation  of  people,  several  millions  in  number  near  the 
Chicago  River,  by  their  very  congestion,  created  health  problems  that  difl:'ered 
in  quantity  and  to  a  degree  in  quality  from  those  of  the  other  parts  of  the 
State. 

The  location  of  Chicago  did  not  jjresage  good  health.  There  were  no 
currents  in  Lake  Michigan  by  which  sewerage  and  soil  pollution  could  be 
kept  awav  from  the  water  supply  and  the  city  was  near  the  lake  head  where 
these  forces  are  most  potent  for  harm.  The  country  was  flat  and  drainage 
was  not  possible.  Mosquitoes  abounded.  Long  John  Wentworth  makes  the 
statement  that  there  were  no  mosquitoes  in  the  Chicago  area  prior  to  the 
opening  of  the  Illinois-Michigan  Canal  but  in  this  he  was  mistaken.  This 
statement  is  found  in  his  address  on  the  early  days  in  Chicago  made  in  his 
later  life  long  after  the  opening  of  the  canal.  Doubtless  his  recollection  of 
things  political  and  economic  was  correct  but  lie  forgot  the  mosquitoes.  He 
is  contradicted  by  a  number  of  witnesses  who  wrote  when  the  matter  was 
fresh  in  their  minds. 


102  HEALTH    IX  SOME  CITIES   rUIOK  TO   1877 

(j'ordDii  Salstciistill  liuljl)ard  writinL;  nf  his  first  ])(irtage  through  Mud 
l.akc.  C'liicagii.  in  <  )ct<il)cr,  iSlS,  says.  "'I  lie  lake  was  full  of  these  almniin- 
aliit-  Iliads  iilagues  (leeches  or  hlnod  suckers)  and  they  stuck  so  tight  t<i  the 
skin  that  ihey  hroke  in  pieces  if  force  was  used  to  remove  them.  The  use 
of  tobacco  lo  remove  tliem  was  resorted  to  with  good  success.  Having  rid 
ourselves  of  the  hlood  suckers  we  were  assailed  by  myriads  of  mosquitoes 
which  rendered  sleep  hopeless." 

In  spite  of  all  this  the  indications  are  that  U]i  to  1,S()3  or  thereabouts 
the  people  of  the  Chicago  area  had  ratlier  better  than  average  health.  There 
is  no  record  of  great  departure  from  normal  iieaUh  among  the  Indians  of  the 
area  or  among  the  b'rench-Canadians  nor  among  the  other  inhabitants  ]irior 
to  the  beginning  of  immigration  from  the  other  states.  The  travellers  of  the 
period  who  visited  Chicago  generally  referred  to  the  lake  water  as  healthy 
though  one  statement  to  the  contrary  was  found. 

In  1.S(I4  Surgeon  Ceneral  Forry  of  the  U.  S.  Army  wrote  of  the  Cliicago 
Region — "This  position  is  one  of  our  most  salubrious  stations."  But  right 
at  this  ])oint  the  story  changes.  Ouaife"'  says,  "Soon  after  the  arrival  of 
troops  (  ISOli)  they  sutiered  nnich  from  bilious  fever." 

\\  histler  reported  "that  in  one  year  after  I-'ort  l/)earborn  was  occupied 
more  than  one-half  the  men  had  been  ill." 

In  lSv!()  Dr.  Alexander  W'olcott  came  to  the  fort  as  an  Indian  agent. 
He  wrote.  "The  fevers  of  that  season  were  unusually  rapid,  malignant  and 
unmana.geable."  The  reports  of  this  period  indicate  that  lualaria  was  very 
prevalent.  Excerpts  from  records  and  writings  of  the  period  as  chronicled 
by  Ranch''-  and  Koehler''^  are  here  presented  to  show  the  major  facts  relat- 
ing to  the  health  and  sanitation  of  Chicago  from  IS-^'.i  to  ls;(i: 

1829.     Fort  Dearborn  troops. 

Man  strength  of  the  garrison 01 

Diseases,    intermittent    fever 17 

Respiratory  organs    11 

Digestive  organs  30 

1S30.     Man  strength  of  the  garrison 90 

Deaths  from  remittent  fever 15 

However,  in  tiiat  year  the  Canal  commissioners  wrote,  "Tiie  inhabitants 
say  the  site  is  decidedly  healthy." 

183"2.  In  this  year  cholera  attacked  General  Scott's  troops  en  route 
to  the  151ack  Hawk  War.  The  rate  was  -.'(lO  ])er  lOOO.  There  were  forty- 
eight  deaths,     llecause  of  the  ejiideniic  these  troops  never  got  to  the   front. 

1833.     The  first  sanitarx;  ordinance  was  jiassed. 

»' Quaife   (Chit-ago  ami  the  Old  Northwest). 
•2Rauch    (Sanitary   History  of   Chicago,  Chicago,  ISTl). 

''Koehler   (Annals  of  Health  and  Sanitation    Octennial    Report    of    Department    of 
Health,   Chicago,   years  1911-18,  Chicago,   1919). 


HEALTH  IN  SOME  CITIES  PRIOR  TO   1S7T  103 

1834.  A  temporary  board  of  health  was  formed  and  also  a  cholera 
vigilance  committee.  These  activities  were  inaugurated  in  order  to  fight 
cholera  which  threatened.    When  cholera  did  not  appear  all  this  lajjsed. 

183j.  Another  board  of  health  was  appointed  consisting  of  seven 
members. 

183;.  Chicago  was  incorporated  and  a  board  of  health  was  appointed. 
They  appointed  a  health  officer. 

1838.  Nearly  all  who  resided  along  the  line  of  the  canal  excavation 
had  malaria  as  did  the  laborers  digging  the  canal.  ".\  very  deadly  and 
strange  epidemic  appeared;  it  was  called  the  canal  cholera." 

1840.  City  got  a  water  supply  from  the  lake. 

1841.  "An  ordinance  recjuiring  reports  of  deaths  was  passed  hut  was 
not  enforced  for  several  years." 

1843.  One  hundred  and  twenty-nine  deaths  were  located  by  means  of 
inquiries  of  undertakers.      (This  was  Chicago's  first  mortality  record.) 

1844.  "Inquiry  among  undertakers  discovered  306  deaths.  A  violent 
epidemic  of  scarlet  fever  was  responsible  for  many  of  these." 

1S4.J.  Scarlet  fever  still  prevailed.  Board  of  health  practically  de- 
funct for  several  3'ears. 

1S4S.     Chicago  had  a  smallpox  scare. 

ISIil.  In  April  forty-five  district  health  officers  were  appointed. 
Cholera  appeared  in  that  month.  In  that  year  there  were  087  deaths  due  to 
cholera.  In  one  month  there  were  1000  cases  and  314  deaths.  Great  activity 
in  sewer  building.     Smallpox  also  prevailed. 

1850.  Cholera  again  appeared.  In  one  month  41  li  persons  die<I  from 
the  disease.     Smallpox  still  prevalent. 

18.")!.  .X  new  city  charter  gave  much  larger  powers  in  health  matters 
to  the  city  council.  A  committee  of  the  Chicago  Medical  Society  reported 
the  mortality  rates  184(i  to  1850.  That  of  1850  was  40. C  per  1000.  Small- 
pox and  cholera  present. 

1852.  Cholera  was  present.  The  number  of  deaths  caused  by  it  was 
030.  From  1849  to  1852  inclusive,  1!)44  died  from  cholera  which  represents 
one  death  per  each  04  of  the  population.  Smallpox  prevailed.  The  Marine 
Hospital  was  opened.  During  the  first  three  months  the  hospital  treated 
20  cases  of  malaria.     The  city  health  ofticer's  salary  was  $500  per  year. 

1853.  Smallpox  more  prevalent. 

1854.  There  were  1424  deaths  from  smallpox.  Cholera  present. 
Cholera  and  smallpox  hospitals  were  maintained. 

1854  and  1855.  There  were  1571  deaths  from  cholera  or  one  for  each 
92  of  the  population. 

1855.  Deaths  from  smallpcjx  30;  from  cholera  147. 


104  IIF.AI.TII    IN   SO.MK  CITIKS   PRIOR  TO    1877 

1S.")(;.  (lencral  liraltli  licttcr.  Xo  deaths  from  chulc-ra  but  Ivplmid 
was  on  tliL-  increase.      lyphoid  ver\-  ijre\alent  in  September. 

1S.")7.  iioard  of  health  went  out  of  existence.  Malaria  death  rate 
was  oS.Ct  per  100,000,  the  highest  rate  shown  by  the  records.  .Also  an  epi- 
demic of  dysentery  which  was  very  fatal. 

1.S5.S.  Scarlet  fever  still  prevailed  and  dysentery  was  \ery  prevalent 
in  children  during  the  summer  months.  Tuberculosis  death  rate  was  31I2.2 
l)er  100,000,  highest  in  the  history  of  the  city. 

IS.")!).  .Scarlet  fever  still  prevalent.  The  death  rate  from  scarlet  higher 
than  that  from  any  other  disease.     Many  sewers  built. 

ISCO.  I!oard  of  health  abolished.  Raising  of  the  city  grade  completed. 
The  term  typhus  fever  disappears  from  the  mortality  records  this  year. 

isi;-.'.  Policeman  Perry  appointed  acting  health  officer.  Diphtheria 
and  smallpox  prevalent.  Increase  in  deaths  from  all  causes.  Typhoid  and 
scarlet  fever  increased  especially.     P>ridgeport  sewerage  pumps  started. 

]S(i;5.  Death  rate  increased.  There  were  94?  cases  of  smallpox.  Epi- 
demic of  erysipelas  present.  This  outbreak  was  studied  by  Dr.  Edmund 
Andrews  who  showed  how  the  disease  prevailed  along  the  filthy  Chicago 
River  and  in  the  unsewered  parts  of  the  city. 

1864.  The  result  of  the  almost  total  neglect  of  sanitary  laws  during  the 
past  five  years  in  addition  to  the  fact  that  the  construction  of  sewers  did  not 
keep  pace  with  the  increase  of  population  is  apparent  from  the  great  mortality 
of  this  vear.  Compared  with  18()3  there  was  a  great  increase  of  cholera 
infantum  and  cholera  morbus.  Erysipelas  and  the  low  grades  of  fevers 
almost  doubled  and  smallpox  trebled.  There  was  a  great  increase  in  diar- 
rhoea and  dysentery.  There  were  nearly  five  times  as  many  deaths  from 
measles  and  a  great  many  more  from  pneumonia. 

.\nother  remarkable  fact  is  that  only  164  more  died  in  the  last  si.x 
nioiilhs  than  in  the  first.  Erysipelas  continued  to  be  epidemic  until  July. 
This  vear  witnessed  the  first  great  increase  in  pneumonia  and  the  first 
tendency  to  a  change  in  the  seasonal  distribution  of  fatal  disease  from  a 
summer  to  a  winter  peak.  The  tendency  was  scarcely  perceptible  for  sev- 
eral years. 

]8t).-).  The  high  pneumonia  rate  continued.  The  efi:'ect  of  the  heat  and 
sudden  change  increased  the  mortality  particularly  among  the  children. 
Fear  of  cholera  stimulated  owners  of  property  to  make  sewer  connections. 
Cholera  was  reported  on  its  way  and  Dr.  T.  B.  Bridges  was  appointed  health 
officer. 

1866.  A  total  of  1,581  cases  of  cholera  occurred.  Health  officer  was 
given  ;52  assistants.  The  death  rate  was  32.55  per  100.000.  The  death  rate 
of  chilclren  under  5  was  high.     '"The  heavy  rainfall  from  July  to  October  in 


IlKALTII   IN   SOME  CITIES   PRIOR  TO    IS'!';  105 

connection  with  the  localities  in  which  cholera  occnrred  goes  far  toward  cor- 
roborating- the  ground  water  theory  of  I'ettenkofer",  says  Dr.  Ranch. 

186T.  Chicago  organized  a  board  of  health  which  followed  the  lines 
of  the  Metropolitan  Board  of  Health  of  New  York  of  which  Dr.  Stephen 
Smith  was  the  moving  spirit.  The  Chicago  board  made  Dr.  Hosmer  A.  John- 
son president  and  Dr.  J.  H.  Ranch,  a  former  surgeon  in  the  Civil  War, 
as  its  executive  officer  with  the  title  sanitary  superintendent.  Dr.  Ranch 
was  an  unusual  health  officer  for  his  day.  Dr.  Arthur  R.  Reynolds,  formerly 
commissioner  of  health  of  Chicago,  has  written  a  good  short  sketch  of  the 
life  of  Dr.  Ranch.  (Three  Chicago  and  Illinois  Public  Health  i  fficers.  J.  11. 
Ranch,  Oscar  C.  Dewolf,  F.  W.  Reilly,  lUdletin  Societ\-  ^Medical  History  of 
Chicago,  August  1912.) 

The  only  diseases  which  prompted  municipal  action  were  sniallpo.x  and 
cholera.  Little  attention  was  jiaid  to  health  ordinances  until  ISp.i,  when 
the  city  was  threatened  with  cholera. 

Drainage  was  inaugurated  after  the  great  cholera  epidemic  nf  1854. 
Sewer  building  lagged  from  1856  to  18GG  wdien  cholera  again  started  sewer 
building.     The  agitation  against  privy  vaults  began. 

.\n  epidemic  map  by  Dr.  Mannheinier  in  the  report  of  the  dejmrtment 
for  this  vear  shows  the  distribution  of  an  epidemic  of  erysipelas  in  18fi3  and 
one  nf  cholera  in  186G.  Erysipelas  followed  the  river  and  lia<l  sanitatiun. 
povert}-  and  congestion  more  closely  than  cholera  did. 

1868.  Dr.  Mannheimer's  second  chart  appeared ;  showed  the  seasonal 
distribution  of  disease  and  correlated  the  weather  changes  with  the  death 
rate.  The  report  contains  an  elaborate  study  of  Texas  tick  fever.  Smallpox 
continued,  with  1,286  cases  and  150  deaths. 

1869.  "Owing  to  the  low.  wet  and  le\el  ])lain  upim  which  Chicago  is 
situated  its  proper  drainage  is  me  of  the  sanitary  problems  of  the  age.  When 
the  population  was  sparse  and  the  winds  had  free  access  to  every  portion 
of  the  city  the  general  health  was  good,  but  as  the  j)opidation  grew  dense 
with  its  necessary  c(jncomittants  of  tilth  and  ofl'al  and  Iniildings  covered 
the  ground  and  the  wind  was  cut  off.  the  city  became  unhealthy.  It  was 
not  until  the  cholera  visitations  of  184;)  to  1S55  that  the  citizens  began  to 
realize  that  without  better  drainage  they  would  be  constantly  liable  to  epi- 
demics. Public  meetings  called  in  1854  passed  good  resolutions  but  it  was 
not  until  after  suffering  six  successive  epidemics,  five  of  cholera  and  one  of 
dysenterj^  that  this  conclusion  was  arrived  at",  says  the  annual  report  for 
this  year. 

Idle  re]X)rt  also  gave  the  number  (:}f  sewers  built  each  year  from  1856  to 
1S69,  inclusive.  A  study  was  made  between  the  death  rate  of  the  different 
wards  and  the  iiroportion  of  sewer  main  and  sewered  homes  in  each. 


1()()  Ill-.ALIII    I.\   SOME  CITIES   I'lUOK  TO    IS" 

riiL'  VL-ars  i)t  L;reat  scarlet  fever  epidemics  were  given  as  lSt4-45;  18."J^- 
IS.jS  and   lS(iS-l,S(;;i. 

"I'^rc  in  the  results  of  drainage  and  other  sanitary  measures  it  may  he  in- 
ferred that  the  ju(Hcious  expenditure  of  money  for  sanitary  purposes  is  a 
sound  maxim  of  municipal  economy.  From  past  experience  I  am  satisfied 
that  the  mean  annual  death  rate  can  he  reduced  to  IT  hy  continuing  the 
present  sanitary  and  drainage  regulations  and  therehy  making  Chicago  one 
of  the  healthiest  cities  in  the  world."  I'his  ])rophec\-  h)-  Dr.  J.  H.  Ranch, 
was  made  in  ISC'.I.     The  rate  fell  below  li   many  years  ago. 

ls;o.  Hi^li  mortality  among  children:  !llii  died  from  cholera  infan- 
tum :  (i"2..S  percent  of  all  deaths  in  children  under  .'>  years  of  age. 

ls;i.  This  is  the  year  of  the  fire.  Records  of  the  health  department 
burned.  Smallpox  present.  Death  rate  high.  In  this  year  appeared  an 
extraordinarily  good  report  from  the  (^'hicago  health  dejjartment.  most  of 
the  copies  of  which  were  burnt  in  the  fire. 

\X',2.  15eath  rate  "JI.Cil.  ".'.-'is^  cases  of  smallpo.x.  (/leneral  death  rate 
27. (34.     Death  rate  of  children  under  5  high.     1,150  horses  died  of  e]>izootic. 

1873.  Cholera  appeared.  48  deaths,  1.7<>(i  cases  of  smallpo.x.  Dr. 
Ranch  resigned  as  sanitary  superintendent  on  .\ugust  5,  and  was  succeeded 
by  Dr.  Ben  S.  Miller. 

1874.  Smallpox  present. 

1875.  City  chartered  under  Cities  and  Villages  Act.  This  provided  for 
a  board  of  health. 

187li.  De])artment  of  health  with  a  commissioner  su])erseded  the  board 
of  health.  Greatest  scarlet  fever  epidemic  in  the  history  of  the  cit\'  occurred 
this  year. 

The  health  history  of  Chicago  as  set  forth  in  the  annual  reports  of  the 
health  department  show  the  rather  rapid  development  of  great  health  prob- 
lems. The  seriousness  of  the  situation  was  appreciated  rather  early.  The 
raising  of  the  datum  to  make  drainage  possible  was  begun.  This  work  was 
undertaken  because  it  was  thought  to  be  necessarv  for  health.  .\  desire  for 
health  was  one  urge  though  not  the  jirincipal  one  behind  the  digging  of  the 
Illinois  and  .Michigan  Canal,  .-\lniost  from  the  beginning  Chicago  had  some 
sort  of  a  board  of  health.  In  times  of  great  fear  of  cholera  or  smallpox 
the  board  was  supported:  at  other  times  it  was  neglected.  This  board  was 
not  of  great  imjiortance  so  far  as  prevention  or  even  sustained  study  of  health 
problems  was  concerned  until  the  organizatitm  of  a  real  health  department 
in  18fi7. 

The  iei)ort  of  the  lioard  of  health  ISC;,  Isds  and  ISdl)  is  a  very  v:du- 
alile  (locnment.  It  indicated  that  during  those  years  sustained  studv  of  health 
prolilenis  w;is  made. 


HEALTH    IN   SOME  CITIES   PRIOR  TO    ISTT  lOT 

This  report  gives  the  total  number  of  deaths  all  ages  and  ages  under  5 
and  5  to  10  years,  each  year  from  1843  to  1851.  These  statistics  were  gath- 
ered from  undertakers'  and  sextons'  reports  and  from  clippings  from  news- 
papers and  medical  journals.  Dr.  Ranch  supplied  correctixe  factors  which 
when  applied  made  these  figures  approximatelv  accurate. 

Aiiiiuid  Diath  luiti's. 

From  July,  18ol  t(j  LSiill  the  vital  statistics  are  given  with  increasing 
detail  and  are  probably  increasingly  accurate.  A  study  of  these  figures  sup- 
plies the  following  data : 

Table  11. 

Annual  IJeatii  Rates  per  l.OOO  Population — Chicago,   1S1::3-18T7. 


Year. 

CJeneral 
death  rate. 

\esir. 

General 
death  rate. 

Year. 

General 
death  rate. 

1843 

18.60 

1855 

27.26 

1867 

21.21 

1844 

33.04 

1 856 

24.8 

1868 

23.74 

1845 

28.46 

1857 

27.56 

1869 

23.17 

1846 

27.81 

1858 

25.06 

1870 

23,88 

1847 

33.93 

1859 

21.59 

1871 

20.87 

1848 

31.86 

1860 

20.73 

1872 

27.64 

1849 

73.  SO 

1861 

18.99 

1873 

25.15 

1850 

48.96 

1862 

20.52 

1874 

20.30 

1851 

27.26 

1863 

25.83 

1875 

19.72 

1852 

46.70 

1864 

26.26 

1876 

21.03 

1853 

22.41 

1865 

22.57 

1877 

18.67 

1854 

64.02 

1866 

32.55 

While  recognizing  the  inaccuracy  of  the  figures  they  are  sufficiently 
complete  to  show  a  general  picture  of  the  health  conditions  at  the  time.  Tak- 
ing out  certain  years  for  reasons  presently  to  be  stated,  the  average  death 
rate  for  what  is  left  of  1S43-41I  inclusive,  is  found  to  be  :il.(i'.'  per  l,(i()() 
population.  For  lS."iO-.3!»  inclusive,  it  is  •-' l.o:!  :  LsGO-Cl)  inclusive  it  is  •.'•J..")(i; 
for  ls7()-7!)  inclusi\e  it  is  1!).^*  ;  1S|:;  is  withheld  because  it  is  obviously 
inaccurate;  Is  I!)  is  reported  as  having  a  death  rate  of  73. NO,  more  than  twice 
that  of  any  jireceding  year.  It  is  withheld  because  it  is  freakish.  One  of 
the  outstanding  causes  of  the  great  death  rate  of  that  year  was  the  prevalence 
of  cholera.  In  the  next  decade,  1S.")(l  with  a  rate  of  4S.!Hi  and  IS.")-..;  with 
one  of  4U.7U  are  withheld.  IS.")!)  was  a  cholera  year.  Is.ji  was  a  cholera 
year.  1866  is  held  out  as  being  abnormal.  It  will  be  noted  however  that  ISIil! 
had  a  death  rate  that  was  only  a  fraction  higher  than  the  prevailing  rate 
in  1843  to  1849.  ]S()6  was  a  cholera  year.  In  the  decade  187(l-:!>,  1S7-.' 
and  1873  with  rates  of  '.^7.64  and  ■,'5.1.")  are  held  as  being  abnormal.  The 
great  influenza  pandemic  was  the  princi])al  cause  of  the  abnormalit\-  though 
both  cholera  and  smallpox  prevailed. 


108 


HEALTH    IX   SOMK  CITIKS   PRIOR  TO    1S7 


This  study  shows  a  I  airly  satisfactory  decrease  in  the  a\"erage  death 
rate  hetween  18-13  and  l.'-^so  but  the  decrease  was  occasionally  interrupted 
1)V  great  epidemic  \va\es.  I'he  increase  in  efforts  to  promote  health  more 
than  equalled  the  increasing  tendency  toward  bad  health  due  to  poor  drain- 
age, water  polhuidn.  sewerage,  contamination,  crowding,  \totn-  liousing  and 
ra|ii(l  immigration. 

'I'l/jjlinid  Mortaliit/. 

An  interesting  item  of  the  general  health  picture  is  the  yearly  death 
rale  from  tv[ilioi<l  fever.     It  was  as  shown  in  Table  12. 


Table  1-2. 

Annual  Death  Rates  from  Typhoid  Fever  per  10(.),000  Population- 
Chicago,  LS52-18T9. 


Tvphoid 

Tvphoid 

Year. 

Tvphoid 

lear. 

ileath  rate. 

death  rate. 

death  rate. 

1852 

152 

1862 

61 

1872 

142.6 

1853 

59 

1863 

99 

1873 

71.6 

1854 

164 

1864 

128 

1874 

53.4 

1855 

62 

1865 

106 

1875 

51.7 

1856 

109 

1866 

106 

1876 

41.2 

1S57 

120 

1867 

73.3 

1S77 

37. 

1858 

61 

1868 

79.3 

1878 

33.4 

1S59 

61 

1869 

65.3 

1879 

42.3 

1S60 

44 

1S70 

87.4 

1861 

61 

1871 

61 

In  the  eight  years  ]8,")2-.")9  inclusive  the  typhoid  death  rate  per  100,000 
poi>ulati(in  was  ItS.-j.  However,  in  this  period  there  were  at  least  two  years 
1852  and  1854  that  were  much  aliove  the  average.  They  were  abnormal 
for  some  reason. 


I)il,llfln  I  Id   MniUllitll. 

During  the  years  1.S52-59  the  average  diphtheria  death  rate  was  lOG.l 
])er  100,000  population.  During  the  decade  ISGU-GD  it  was  15G..S.  During 
18:0-:9  it  was  112. OS.  In  this  ])eri(id  of  28  years  for  much  more  than  half 
the  time  dii)htheria  outranked  typhoid  as  a  cause  nf  death.  The  great  wave 
which  >tarted  in  l,s5:,  while  it  tluctuated,  di<l  nut  yield  materially  until 
ISdT.      The  great  wave  which  started  in   is^i;  did  not  let  up  until   l.sii5. 


HEALTH   IX   SOME  CITIES   rUKIU  TO    187T 


loa 


Table  13. 
Annual  Death  Rates  from  Dii'iiTiiEKrA  per  KiO.Ooo  Population- 
Chicago,  1852-18T'J. 


Diphtheria 

Diphtheria 

Year. 

Diphtheria 

death  rate 

death  rate. 

death  rate. 

1852 

78 

1862 

133 

1872 

97.2 

1S53 

57 

1863 

203 

1873 

62.1 

1854 

82 

1864 

150 

1874 

44. 

1855 

62 

1865 

230 

1875 

67.2 

1856 

35 

1866 

115 

1876 

184.5 

1857 

172 

1867 

79.1 

1877 

135.8 

1858 

193 

1868 

77.4 

1878 

120.2 

1859 

168 

1869 

91.8 

1879 

196.9 

1860 

269 

1870 

139.3 

186! 

220 

1871 

73.6 

Scarlet  Fever  Morfalif//. 

The  average  annual  mortality  rate  from  scarlet  fever  of  five  years  be- 
tween 1852  and  1859  was  61. 8  per  100,000  population;  of  seven  years  be- 
tween 1860-1869  was  61.6 ;  of  seven  years  1870-77  was  44.3.  1855  was  with- 
held because  the  rate  was  abnormally  low.  1858-59-62-63-69-7  6  and  77  be- 
cause they  were  abnormally  high.  The  disease  increased  in  the  late  fifties 
and  in  the  early  sixties.  It  is  probable  that  the  decrease  in  scarlet  fever 
began  in  1870  but  the  very  bad  epidemic  of  1876-1877  must  not  be  lost  sight 
of.  It  is  proper  to  say  of  scarlet  fever  that  the  efforts  put  forth  to  control 
the  disease  just  about  balanced  the  tendency  of  the  disease  to  spread  and 
grow  worse  with  increasing  pi  ])ulation.  The  great  waves  of  the  disease 
generally  lasted  two  years.  There  w  ere  maii\-  years  when  scarlet  fever  was 
responsible  for  a  higher  death  rate  than  that  of  typhoid  fever. 

Table  14. 

Annual  Death  Rates  from  Scarlet  Fever  per  100,000  Population — 

Chicago,  1852-1879. 


Scarlet  Fever 

Scarlet  Fever 

Year. 

Scarlet  Fever 

death  rate. 

.leath  rate. 

death  rate. 

1852 

117 

1862 

294 

1872 

34.8 

1853 

59 

1863 

260 

1873 

30.3 

1854 

3S 

1864 

43 

1874 

26.6 

1855 

6.2 

1865 

52 

1875 

51.4 

1856 

13 

1866 

63 

1876 

198.9 

1857 

82 

1867 

44.9 

1877 

190.5 

1858 

243 

1868 

72.2 

1878 

30.3 

1859 

262 

1869 

204.6 

1879 

79.1 

1860 

113 

1870 

99.5 

1S61 

40 

1871 

37.1 

Piirinii())iia)<. 

Cnder  this  head  are  grou])ed  all  the  deaths  reported  as  due  to  pneu- 
monia, pleurisy,  bronchitis  and  broncho-pneumonia  and  influenza  although 
the  last  term  was  just  coming  into  use  at  the  end  of  the  period. 


110 


IIEAI.TII    IN   SO.Ml-:  CiTllCS   TKIOK  TO    IS?? 

Table  15. 


Annual  Death  Rates  FRt)M  Acute  Respikatorv  Diseases  per  100,000 
Population — Chicago,  1852-1879. 


Year. 

Rate. 

Year. 

Kate. 

Year. 

Rate. 

1852 

87 

1862 

67 

1872 

174 

18S3 

31 

1863 

125 

1873 

171 

1894 

63 

1864 

135 

1874 

134 

185S 

70 

1865 

99 

1875 

172 

1856 

62 

1866 

119 

1876 

137 

1857 

71 

1867 

86 

1877 

122 

1858 

93 

1868 

165 

1878 

152 

1859 

64 

1869 

134 

1879 

140 

1860 

49 

1870 

143 

1861 

54 

1871 

146 

The  death  rates  from  acute  respiratory  diseases  from  1852  to  1879  are 
shown  in  Table  15. 

In  the  1S52-5U  decade  the  wiirst  year  was  1858 — 95;  the  best  1853 — 
■"il  ;  the  average  was  ;o.  In  the  ne.\t  decade  the  worst  year  was  1S()8 — l(i5  ; 
the  liest  lS(.;(i — 19;  the  avera^je  was  111:!.  Tile  acute  resjiiraforv  disorders 
were  getting  worse.  Xo  exjilanation  was  fduiul  for  the  great  upward  jump 
in  186;5  and  a  similar  jump  in  18G8.  in  tlie  next  decade  the  worst  year  was 
1812 — 174;  the  best  was  18;  T — 122;  the  average  was  119.  The  fatal  acute 
respiratory  infections  were  rapidly  increasing.  In  less  than  thirty  years 
the  a\erage  for  a  ten  year  |)eriod  had  more  than  doubled.  The  increase 
continued  until  the  early  part  of  the  twentieth  century  since  which  time  there 
has  been  a  slight  decrease  except  in  the  years  (if  the  great  1918  influenza 
].)andemic  an<l  its  recurrence  in  1920.  The  high  rates  of  18T2  and  1873 
w(  re  due  to  the  pandemic  of  influenza  wliich  prexailed  in  those  )'ears. 

('(iiisiniiiifidii. 

'i"he  deatli  rate  from  cmisumiitidn  li\'  \ear>  is  shdwn  in  Table  lii. 

In  spite  of  I  lie  repeated  statement  that  there  was  no  consum])tion  in 
Illinois,  (ir  but  little,  the  rate  the  first  year  the  record  was  begun  in  Chicago 
was  299  per  100, OOO  pojiulatinn.  It  is  ikiw  in  the  vicinity  of  75.  The  worst 
record  in  Chicago's  bisliir\'  was  :;70  m  l.s;5S.  The  average  for  the  decade 
was  298.  The  worst  year  in  tlie  next  decade  was  18(;9,  2(19.  the  best  1865, 
187.     The  average  was  2:11.5.     Ccinsumptidu  apjieared  to  be  mi  the  decline. 

In  the  next  decade  the  ^yorst  year  was  \s]0  with  281  ;  the  best  1879, 
173;  the  average  was  22S.  a  fuitbur  decliiu-  thciugh  a  small  one.  This  de- 
cline showed  a  disposition  lo  slop  in  the  early  part  of  the  twentieth  century. 

I'nder  ilie  impetus  of  a  new  type  of  activity  in  control  it  began  again. 
.\t  tlie  time  of  writing  (in  l!i2;)  it  has  again  come  to  a  stop.  There  has 
bei  n  no  decline  for  several  years. 


HEALTH    IX   SOME  CITIES   PRIOR  TO    187' 


111 


Table  16. 

Annual  Death   Rates  from   Consumption   per  100.000   Population- 
Chicago.  1853-1880. 


Year. 

Death  rate. 

Year. 

Death  rate. 

Year. 

Death  rate. 

1853 

299 

1863 

188 

1873 

244 

1854 

324 

1864 

242 

1874 

218 

1855 

201 

1865 

187 

1875 

219 

1856 

341 

1866 

203 

1876 

217 

1857 

288 

1867 

240 

1877 

1858 

370 

1868 

24S 

1878 

196 

1859 

274 

1869 

269 

1879 

173 

1860 

251 

1870 

281 

1880 

195 

1861 

265 

1871 

248 

1862 

247 

1872 

274 

Siiiifil po.r  Miiitalifij. 

The  years  18-52-n  had  an  average  smallpox  death  rate  of  3(i.l  ;  ]8(jO-(59 
an  average  of  -j^.HG  ;  1870-7!)  an  average  of  i:).17.  In  1857  there  was  a  bad 
small])! IX  (intljreak  and  it  extended  into  1S5!».  But  ls5l)  was  the  only  \"ear  in 
the  earh  history  of  Chicago  ^ter  1S5-.'  that  did  not  record  a  death  fmni  the 
disease.  lS(i:;  and  1804  were  years  of  l)ad  epidemic  conditions  but  there 
was  a  low  rate  (i.l  in  18(il);  187"2  and  bS'o  were  bad  epidemic  years,  is;;) 
had  a  rate  of  onlv  .5.  The  disease  wa>  more  than  holding  its  own  against 
society  until  ISiili.  Frdin  that  time  on  it  lost  ground  though,  in  ls;-J  and 
is;:!  it  again  more  than  held  its  own.  The  epidemic  waves  were  farther 
apart  and  in  the  low  years  the  disease  was  near  the  vanishing  point. 


Table  17. 

Axxu.\L  Death  Rates  from  Smallpox  per  lOO.doO  Population — 
Chicago.  1853-1879. 


Year. 

Death  rate. 

Year. 

Deatli  rate. 

Year. 

Death  rate. 

1852 

23 

1862 

36 

1872 

178.3 

1853 

32.1 

1863 

76.6 

1873 

136.1 

1854 

18.2 

1864 

166.6 

1874 

22.8 

1855 

37.5 

1865 

317. 

1875 

2.5 

1856 

19. 

1866 

45. 

1876 

7.1 

1857 

114. 

1867 

54.7 

1877 

10. 

1858 

55. 

1868 

57.9 

1878 

4.8 

1859 

0. 

1S69 

6.1 

1879 

.2 

1860 

27. 

1870 

4.9 

1861 

25. 

1871 

21.8 

Measles  Mortality. 

Between  1852  and  1851)  the  yearly  average  death  rate  from  measles  was 
33  per  100,000  population.  18C0-G9  it  was  37.5  ;  1870-79  it  was  18.44.  1S53- 
1854  and  1857  were  bad  measles  years  whereas  1859  had  a  low  death  rate 


112 


HEALTH    IX   SOME  CITIES   I'KIOK  TO    1  S  ^  1 


of  1(1.';.  Ill  tin-  iifxt  decade  iSG-t  and  ISCti  were  bad  measles  years.  1865 
was  low  with  II.  'J'he  rate  in  18C6  was  the  highest  Chicago  ever  knew. 
18T1  had  an  epidemic  but  scarcely  comparable  with  that  of  1866,  1874,  18T6 
and  1878  had  rates  well  under  10.  The  records  show  that  untiljl876  measles 
was  winning  its  fight  against  society.  Since  then  society  has  been  gaining 
the  upi)cr  hand  but  backslides  occur  occasionally. 


Table  18. 

Annu.al  Death  Rate  from  Measles  per  100,000  Population — 
Chicago,  1852-1879. 


Year. 

Death  rate. 

Year. 

Death  rate. 

Year. 

Death  rate. 

1852 

34.6 

1862 

28.5 

1872 

10. 1 

1853 

52.1 

1863 

18.6 

1873 

27.6 

1854 

69. 

1864 

78.3 

1874 

3.8 

1855 

11.5 

1865 

11. 

1875 

29.2 

1856 

19. 

1866 

83 

1876 

3.7 

1857 

43. 

1867 

39.1 

1877 

13.7 

1858 

24.2 

1868 

42.5 

1878 

8.2 

1859 

10.7 

1869 

38.9 

1879 

10.4 

1860 

13.6 

1870 

31. 

1861 

21.6 

1871 

46.7 

Wltnnji'nui  (.'i)ii<iJi  Miirfdiiti/. 

The  average  annual  innrtalit\  from  whooping  cough  for  is.j2  to  185!) 
was  23.7  per  100,000  population.  IS(JO-Gl)  was  33.5;  1870-1871)  was  20.19. 
The  years  1854,  1863,  1866,  1869  and  1878  were  bad  whooping  cough  years. 
There  is  no  evidence  that  Chicago  was  gaining  in  the  control  of  this  disease 
lirior  to  1880. 

Table  19. 

Axnual  Death  Rates  from  W'hoopixc^  Cough  per  100. ooO  Population — 
Chicago,  1852-1879. 


Year. 

Death  rate. 

Year. 

Death  rate. 

Year. 

Death  rate. 

1852 

18 

1862 

21 

1872 

33.8 

1853 

29 

1863 

62 

1873 

40.8 

1854 

52 

1864 

11 

1874 

27.1 

1855 

24 

1865 

8 

1875 

26.5 

1856 

n 

1866 

92 

1876 

32.6 

1857 

22.5 

1867 

27.6 

1877 

12.1 

1858 

20.5 

1868 

25 

1878 

53.8 

1859 

12.5 

1869 

46.8 

1879 

6.7 

1860 

21.6 

1870 

29.7 

1861 

20. 

1871 

18.8 

HEALTH   IN  SOME  CITIES  PRIOR  TO   187' 


113 


Malaria  Moiialify. 

The  average  malaria  annual  death  rate  1853-9  was  51.1  per  100,000 
population:  18G0-(i!)  it  was  20.8;  ] 870-79  it  was  still  falling.  It  was  not 
until  1909  that  malaria  disappeared  from  the  causes  of  death  in  Chicago 
but  it  was  plain  by  1880  that  the  disease  was  coming  under  control  and  would 
eventually  disappear. 

Table  30. 

Annual  Death  Rates  from  Malaria,  Congestion,  Intermittent  and 
Remittent  Fevers  per  100,000  Population — Chicago,  1852-1879. 


Year. 

Death  rate. 

Year. 

Death  rate. 

Year. 

Death  rate. 

1852 

102 

1862 

15.5 

1872 

15.5 

1853 

57 

1863 

18. 

1873 

16.5 

1854 

10.5 

1864 

18. 

1874 

7.8 

1855 

37.5 

1865 

17. 

1875 

11. 

1856 

26.5 

1866 

37. 

1876 

15.2 

1857 

55. 

1867 

19. 

1877 

4.8 

1858 

16. 

1868 

22. 

1878 

13.5 

1859 

10. 

1869 

27. 

1879 

9.0 

1860 

22. 

1870 

15.9 

1861 

12.5 

1871 

10.4 

Baby  Death  Rates. 

It  would  be  interesting  to  know  what  has  been  the  improvement  in  the 
health  of  babies  as  shown  by  the  infant  mortality  rate  since  1833.  But  this 
will  i)rove  impossible,  because  in  some  years  there  were  no  vital  statistics, 
while  in  other  years  the  groupings  were  not  uniform. 

Beginning  in  1843  such  statistics  as  are  available  show  that  the  health 
authorities  understood  the  relation  of  the  health  of  the  children  tn  the  wel- 
fare of  the  community.  In  that  year  there  is  a  record  of  139  deaths  all  ages 
(it  whom  .'37  were  of  children  under  5  years  of  age  and  10  of  children  5  to  10 
\ears  nf  age.  No  other  data  are  given.  This  is  the  classification  that  was  fol- 
lowed until  l.s.")4.  In  that  year  a  group  "above  70  years"  is  added.  This 
was  the  age  grnuiiing  made  use  of  for  many  years.  The  present  classilica- 
tiiin  into  deaths  from  all  causes  of  babies  under  1  and  deaths  from  tliar- 
rhoeal  diseases  in  children  under  3  was  not  employed  for  manv  years. 
I"'iiially  the  number  of  births  as  a  basis  for  determining  baby  death  rate  was 
not  available  in  Chicago  until  very  recent  times.  There  is  a  mass  of  testi- 
mony from  health  officers  and  physicians  that  the  infant  mortality  in  these 
early  years  was  excessively  high  but  there  is  no  statistical  data  from  which 
the  exact  facts  can  be  adduced. 

The  earlier  records  do  not  separate  deaths  from  diarrhoeal  diseases  into 
deaths  of  children  and  deaths  of  adults.     It  is  known  from  health  officers 


Ill 


IIKAI.TII    IN    SOMI'".   fiTIF.S    I'UIOk   TO    1 S  ,  , 


and  j)h_\sicians  tlial  in  the  early  (la\s  the  death  rates  of  aduhs  from  diarrhoea 
and  dysentery  were  heavy.  These  have  disappeared  as  a  cause  of  death  of 
adults,  hut  there  are  no  statistics  on  the  suhject. 


Tahle  21. 

.\nnual  Death    Rate  erom   Erysipelas  per   100, ()()()   T'opul-vtion — 
Chicago.  1852-1869. 


Year. 

Death  rate. 

Year. 

Death  rate. 

Year. 

Death  rate. 

1SS2 

13 

1858 

4.4 

1864 

20.5 

1853 

17 

1859 

4.3 

1865 

11. 

1854 

10.5 

1860 

3.6 

1866 

10.5 

1855 

4. 

1861 

2.5 

1867 

7 

1856 

1.2 

1862 

3.6 

1868 

10. 

1857 

6.8 

1863 

12. 

1S69 

11. 

Erijsipclas  Mdiialilii. 

1  he  avera,L;e  annual  death  rale  from  erysipelas  lS.12-i)  was  1.*  per 
100.000  population.  ISCO-U  was  !l.i;.  Prior  to  18,0  this  disease  was 
gaining. 

The  earlier  health  authorities  of  Chicago  were  very  much  under  the 
influence  of  the  Pettenkofer  doctrines.  They  devoted  nidsi  of  their  atten- 
tion to  raising  the  city  datum  and  building  sewers,  the  suppression  of  vard 
l)rivics.  removal  of  slaughter  houses  and  other  nuisances — cleaning  the 
streets  and  private  i)remises,  improving  the  filthy  condition  of  tlie  (.'hicago 
River  and  the  water  supplies. 

In  times  of  great  epidemics  they  became  interested  in  reporting  and 
quarantining  but  at  all  other  times  they  were  working  at  sanitation,  the  im- 
provement of  environment.  Of  course  this  was  before  the  days  of  the  germ 
tiieory  and  the  doctrines  of  Pettenkofer  were  paramount  everywhere.  The 
work  they  did  along  these  lines  educated  the  people  and  established  a  sani- 
tary conscience  as  well  as  a  sanitary  intelligence,  which  contributed  to  the 
control  of  disease.  Sanitation  also  contributes  greatly  to  such  control.  It  is 
necessary  ground  work  for  such  control,  but  knowing  what  is  known  now, 
one  can  well  understand  why  disease  did  not  come  un(k'r  cmitrol  as  rapi(ll\ 
in  those  old  Pettenkofer  days  as  men  hoped  for. 

The  records  show  that  further  im|)rovement  followed  the  aiiplication  of 
melhn(l>  leased  on  liie  germ  theorj-  of  disease. 


HEALTH   IX  SO^[E  CITIES  PRIOR  TO   ISTT  115 

Springfield. 

The  lirst  settlement  on  tlie  present  site  of  Springtield  was  made  in  1818, 
the  year  IlHnois  entered  in  Union.  The  town  was  not  regularly  surveyed 
and  laid  out  until  1833.  in  which  year  Elijah  lies  and  Pascal  P.  Enos  j)er- 
formed  the  necessary  service.  At  first  it  was  called  "Calhoun,"  in  honor  of 
the  great  nullifier  of  South  Carolina,  but  the  name  proved  to  be  unpopular 
and  few  people  used  it.  They  preferred  the  name  Springfield,  which  was  the 
name  given  the  postuffice  in  the  embryo  city  of  Calhoun. 

Earlv  in  the  career  of  Springfield,  burn  Calhoun,  the  nnniicipality  began 
acquiring  ])iilitical  lumors,  a  haiiit  wliich  it  shows  no  tendency  to  forsake. 
In  18-,'l,  two  years  before  it  was  officially  laid  out,  it  acquired  the  title  of 
CDUntv  seat  of  .Sangamon  County.  This  was  in  spite  of  the  fact  that  it  was 
not  incori)or,-ited  until  183"^ 

In  1^3^,  as  the  result  of  a  rather  strenuous  political  contest,  it  became 
the  State  cai)ital.  and  the  first  session  of  the  legislature  to  meet  there  as- 
sembled in  ls:!lt.  Abraham  Lincoln,  as  a  niember  of  the  long-nine,  had  much 
to  do  with  the  removal  of  the  State  capital  from  X'andalia  to  Springfield. 
.\mong  the  manv  rumors  of  reasons  for  removing  the  capitol  from  \'an- 
dalia  to  Springfield  were  two  that  relate  to  health. 

One  was  thai  the  legislature  had  grown  tired  of  the  preponderance 
of  venison,  wild  turkey,  wild  duck  and  other  game  meats  supplied  them  at 
\'andalia,  and  thev  moved  the  cai)ital  to  Springfield  where  they  could  get 
more  pork  ami  beef. 

Another  is  that  the  Kaskaskia  l)oltoms  around  N'andalia  made  the  lo- 
cation so  highly  malarial  that  the  legislature  wanted  a  healthier  site  for 
the  State  capital. 

Sangamon  County  was  so  near  the  geographical  and  population  center 
of  the  State  that  it  was  a  popular  prospective  location  for  the  Capitol  as  soon 
as  the  people  began  thinking  in  terms  of  the  State  as  a  whole.  There  is  a 
story  that  the  plan  was  to  place  the  Capitol  at  Illiopolis,  a  town  in  Sanga- 
mon Comity,  about  ten  miles  to  the  east  of  Springfield.  The  name  was 
cut  to  fit.  So  were  the  i)lans,  but  dame  rumor,  or  is  it  scandal,  says,  some 
parties  high  in  power  bought  up  the  land  around  Uliojiolis,  whereupon  the 
indignant  many  not  in  on  the  deal  "kicked  the  fat  into  the  fire''  and  threw 
the  Capitol  into  the  willing  lap  of  Springfield. 

Among  the  books  and  papers  of  the  late  Dr.  A.  \\  .  I'rench,  DDS. ,''■''  of 
Springfield,  was  found  an  old  blank  book,  the  binder's  title  on  the  back  of 
which  is  "Minutes  of  Springfield,  Illinois,  1832-1840."  On  the  fly  leaf  of 
the  book   is   written:      "Minutes   of   Board   of   Trustees  of   the   \'illage  of 


il    lUinois  HLsturiial    Society,  Vol.    2). 


116 


HEALTH    IN  SOME  CITIES  PRIOR  TO   18T7 


Springfield,  Illinois,  of  ils  meetings  from  A]iril   is:',-.'   (  lirst  meeting)   to  the 
organizing  of  a  city  in  ls:!!i.'' 

On  July  19,  1832,  at  an  extra  meeting  of  the  lioarcl,  the  following  pre- 
amhle  and  some  resolutions  were  read  and  passed  :  "Whereas,  we  have 
information  that  the  Asiatic  cholera  is  now  prevailing  in  Chicago,  and  where- 
as, it  becomes  the  duty  of  the  trustees  to  guard  the  town  from  infection 
from  that  source,",  etc.  The  usual  orders  were  then  made  as  to  the  clean- 
ing of  the  town.  On  November  14,  orders  were  given  out  that  the  court 
house  be  fitted  up  as  a  hospital  in  case  it  was  needed  for  the  cholera  pa- 
tients. Some  indication  of  the  improvement  in  the  health  of  Springfield 
is  indicated  by  Table  22. 

Table  22. 

Annual  Death  R.-\tes  fro.m  all  Causes  and  Certain  other  Diseases — 

Springfield,  III.,  1875-78  and  1923-1926. 

Per  100,000  Population. 


1875 

1876 

1877 

1S78 

1923 

1924 

1925 

1926 

18.553 

18.791 

19.074 

19.357 

61.833 

62,715 

63.923 

17.5 

64.700 

Death  rate  all  causes,  per  1.000  popula- 
tion      

15.3 

14.5 

Death  rate  per  ICO.OOO  poinilation— 
Typhoid  Fever 
Starlet  Fever 

26.5 

26.6 
74.2 
26.6 
85.1 
190.8 
127.2 
26.6 
339.2 

78. 
88.4 
36.4 
26. 

239.2 
72.8 
10.4 

332.6 

56.1 
30.6 
10.3 

102. 

265.2 
56.1 
15.3 

285.6 

4.8 

6.3 

1.5 
4.7 
14.2 
57.4 

6.2 
4.8 
3.1 
4.8 
89.6 

6. 

"WTioopiii!;  f.iiiMli 
Diphtheria- 

5.3 

164.3 
275.6 
153.7 
15.9 

6.4 
12.8 
92.1 
41.6 

16.5 
4.6 

.Malaria.- 

Infant  Deaths  Under  1  Year  .Age 

174.6' 

156.2 

156.1 

75.2 

Springfield's  bad  year  for  typhoid  since  the  keeping  of  records  began 
was  1881,  with  a  rate  of  171.5  per  100,000  population;  for  scarlet  fever, 
1879;  with  a  rate  of  230;  whooping  cough,  1877  with  a  rate  of  36.4;  diph- 
theria, 1875,  rate  164.3;  tuberculosis,  1881,  rate  303.8;  infantile  diarrhoeas 
1875,  rate  153.7;  baby  death  rate,  all  causes,  1880,  rate  433.5;  malaria,  1881, 
rate  29.4. 

Kaskaskia. 

This  town  located  at  the  jjoint  of  junction  of  the  Kaskaskia  or  Okaw 
Ri\er  with  the  Mississippi,  was  founded  by  Marquette  in  1672.  The  earlier 
French  settlers  married  Indians  or  girls  brought  to  Kaskaskia  for  wives 
from  Canada  and  Louisiana.  These  earlier  French  half-lireeds  and  Indians 
enjoyed  good  health  in  spite  of  the  location  of  their  town.  The  Knglish 
took  possession  in  17(5.").  ."-'ettlers  began  to  come  in  from  the  South  in  1770; 
Clark  was  there  in  Ills  and  17^9  to  about  1783.     A  military  garrison  there 


lIEAr.TlI    IX   SOME  CITIES   PklOU  TO 


sut'lcred  severely  from  disease  iluring  some  of  this  time.  There  was  a  United 
States  land  office  there  in  I  sol.  In  ISO'.i  the  Territorial  Capitol  was  located 
in  Kaskaskia  and  there  it  remained  until  the  State  was  organized  in  1818, 
wheren])on  Vandalia  became  the  capital  city. 

Although  in  the  later  years  of  its  existence  the  health  of  the  people  of 
Kaskaskia  was  ])ii(ir  that  was  not  the  reason  fur  the  removal  of  the  capital. 
Overflows  and  the  caving  banks  of  the  adjoining  rivers  brought  that  about. 
However,  had  Kaskaskia  retained  a  large  population  between  1818  and  1877, 
it  would  inevitablv  have  become  a  liotbed  of  malaria,  typhoid,  dysentery  and 
pestilence  general!}'. 

Shawneetown. 

The  principal  reason  for  writing  especially 
of  Shawneetowm  is  the  fact  that  it  was  the  seat 
of  (ine  of  the  land  offices  through  which  the 
colonists  of  other  states  who  located  in  the 
south  end  of  the  State  secured  their  lands. 

In  his  article  on  a  Pioneer  Medical  School 

Dr.  C  E.  Ijlack'"'  of  Jacksonville,  says: 

"When  Illinois  became  a  state  in  ISIS  most 
of  its  inhabitants  were  south  ot  the  mouth  of  the 
Illinois  River." 

.Ml  of  those  who  owned  land  in  this  sec- 
tion had  entered  their  land  through  the  Shaw- 
neetown office.     Many  of  them  had  been  there 
in  person  taking  their  diseases  with  them  and 
'"■  ''■  !'"■  Biaik.  swapping  diseases  while  there. 

In  "rictures  of  Illinois,  One  Hundred  Years  ago"' — (Lakeside  Classics, 
1!)1S)  we  read: 

"Shawneetown  enjoyed  something  of  a  real  estate  boom  in  1S14.  but  due 
to  the  annual  inundation  of  the  Ohio  River  and  to  the  general  unhealthfulness 
of  the  place  the  boom  speedily  collapsed." 


Vandalia. 

\'andalia  became  the  State  capital  in  1818  and  retained  this  honor  until 
some  date  between  1837  and  1839.  It  is  located  on  the  banks  of  the  Kas- 
kaskia River,  which  river  was  sometimes  called  the  Okah.  Elsewhere  iti 
this  narrative  are  accounts  of  malaria  and  other  forms  of  disease  at  \'andalia. 
Most  of  the  reports  were  taken  from  communications  from  Dr.  F.  Haller. 
While  the  low  ground  of  the  Kaskaskia  bottoms  made  Vandalia  a  malarial 


'Black   (III.  Histc 


HEALTH  IN  SOME  CITIES  PRIOR  TO   1877  119 

location  in  the  early  days  that  disease  does  not  appear  to  have  influenced 
the  legislature  to  remove  the  capital.  One  account  says  the  change  was  made 
because  the  only  meat  available  in  Vandalia  was  turkey  and  venison,  of 
which  the  members  of  the  legislature  had  grown  tired.  They  ])ref erred  hug 
meat  and  they  moved  the  cajjital  t<i  .Springfield  where  this  luxury  was 
available. 

\'andalia  is  a  prosperous  city  having  withstood  the  loss  of  the  capital 
better  than  other  cities  have  done.  The  eradication  of  malaria  from  the 
Okah  bottom  has  greatly  increased  the  health  futures.  It  is  in  the  midst 
of  the  belt  in  which  white  snake  root  grows  and  therefore  milk  sickness  long 
remained  a  menace. 


PART  TWO 


Public  Health  Administration. 


Medical  Practice  Act. 


Voluntary  Health  Agencies. 


Health    Conditions   After   1877. 


Summary  and  Conclusion. 


MEMBERS    APPOINTED 

^levjiy  Cratoi  Illinois  State  ho2xi  of  Health. 


*»    ^s 


KoibmLuitlani.  %.r, 

/S77-  IS9<2. 


AftJottL.ClacIi,9Il.D. 

IS7T-  1S93 


JohuH.Kaiu:lvJl.r. 

t$71  •  JSdl 


Wiikt.Cbte,t.P. 
/srr  '!ssi 

J.m.Gtt^oy^LlD. 

tP 

Horace  \l^attbw.t.9Il.l), 

/S7  7  -    jss: 

The  first  lioard  of  Heallh  in  Illinois,  organized  July  12,  IS" 


Newton  Batcniun,  I.L.   D. 

XEWTOX   BATEIIAN.   Galesburg:;  was  born   July   27.    1S22,    Fairfielfl,  Npw   Jersey. 

Taken   l.v   iiMi-.-nts   t..    Illinois   in    ls;!:l       CriuliKiterl    from    lllin..is  c.ll^a,.   :if  .lii.Ksi.nville 

in     ISI::     ,inil     slinli..!     tli.'     id  h.wmL'     v.-.n     :it     ].:,!<,■     '|-|i..il,,i;j,  ;,l     s.-niin,H\  |;.-.:inie    a 

teacli.'i     in     IMi:    ,111.1    li.'l.l    ..     iniinli.r    -r    1.  ,-|m  .n^ilil.'    |M.sin..ii>    m    iml.lh  ,iimI    i.iivate 

schools    lllllll     IN.^N.    wllell    lu-    «;is    .1,  .   l,',l     lo    III.      oil!,.'    ol     .S|:il,.    .SM|i.in iMil     o|      I  ■ublio 

Instruellun,    a    posillull    lie    lieUI    lor    loin  leell    .Vcal.s.       I'le.sulent    ol    Kno.^.    Collii;,,    CaleS- 

burg-,    1875-1S93.      Member    State    Board    of    Health,    ISTT-lSai.      Author    ot    numerous 
historical  books  and  publications.     Died  in  Galesburg,  October  21,   ISII". 


Reuben  l.udhim.  M.  D. 

mo,   lioin    ii.-tober  7,    1.S31,   Camden,   New   Jersey,      Orad- 

,    ol    111,     Iniversity   ot   Pennsylyania,    lsr,L>   ;mm1    went   to 

Cbirasi.,    l,s.5:i.       .M.inli.i     :iiel     .1.   in     r,oiilty    Hahnemann    Medical    (•oll.■l;.^     ImiI-1S99. 

President    of    uunnioiis    iii..lio,il    oi  t;,i  n  i7,:i  I  ions.      Author   of   several    me(li,:il    1 ks   and 

editor     of     professional     journals.       Member     of     State     Board     of     Health.     1S77-1S!I2. 


An.son  L.  Clark,  M.  D. 


AX.S( 

IX 

1 

:..   ci 

Wa; 

s   take] 

11  1 

ly 

IKU-f 

at  1 

\:i\,  si, 

or 

■^ 

III      r 

assi 

1 S 1 : 1  1 1  1 

1    L 

o'.  in 

Ben 

U.   1  1      .\ 

I.I 

ll. 

.ll    1- 

1911 

1.        .\1  e 

jii 

he 

I     271 

1S7' 

:-isi)3. 

A I 

ithor 

1S36,  Clarksburg-,  Massachusetts. 
Craduated  from  Lombard  College 
.\l..li.;il  liisiitute  in  1S61.  First 
\il  W.ii  .111.  ..r  the  founders  of 
[  ii.>ni  lis  ..i  i;.i  nization  in  1S70  to 
.M.inl.ii  St, lie  Board  of  Health, 
'      Died  April    11,    1910. 


William  M.  Chambers,  M.   D. 

WILLIAM  M.  CHAilBEPLS.  Charleston;  born  April  11,  ISH,  Cynthiana,  Kentucky. 
Gradn.itiil  fr.mi  McdirnI  (^.ll.qe  of  Transylvania  University,  Lexington,  1S43.  Went 
to  Col.  s  i'..iiiii\.  llliimis  ill  \s:,:.  Ih-igade  surgeon,  U.  S.  Army,  1861  to  close  of  Civil 
War  w  h.  II  In  u.is  i.i.\.ti..l  I'oi.ni.l  for  meritorious  service.  President  of  numerous 
merii.nl  ..rL:niiiz,iii..iis,  .M.niil..  r  .■^inle  Board  of  Health,  1S77-1SS1.  Died  in  Charleston, 
November    12,    1.MI2. 

John   Milton   Gregory,   LL.    D. 

JOHN  MILTON  GREGORY,  Champaign;  born  July  6,  1S22,  Sand  Lake,  New  York. 
Graduated  ITnion  College,  1S4B,  A.  P..  Studied  law,  Schenectady,  New  York,  1S4B-47. 
Pastor  Hnptist  I'hvir.h    H..osi,k  Falls,  New   York.   lS47-l.'iSO  and  Akron.  Ohio.   1X50-1852. 

Prill,  innl    I  ■l,-.-sn;il    Si  1 1,     |..-lri.il.     1  s,".2-l  s,".:i :    .-.11 1 .  .r    n  ii.l    piil.l  isli.  i  ,    .Mi.lii^nii    ,l..nrnal 

of    |.:.lin,iii..n      l-,-,Ms,-.;.         S r  1 1. 1 .  in  l.ni  I     ..I      I'lil.li.'     InsliM.I ,     .MlIiil:.!!,     I--,..-1S64. 

Presi.i.  ni     Is.il  I  tii.iz ■i.ll.^.-.    K.ilniiinz....,    .\l  I.  li  I  ij ,  i  ii ,     1m;,'.-1s.;t        I;.  -.  ni     il-i.sident) 

lUin..ls    lli.lnsliinl     riilMlslU-.    ISDT'ISMI        r      S     .■i.innilssi I,    \nMn,i     i;  \  | ..  .si  t  l,,n,    1S73. 

lllin..is    Si,iii-   c- ,iissi..ii.-i'  to    l',iiis    i;m...^ii  loll,    1^T^       .\l.ni.l..-i      hhI    |.i.sident    (ISSl- 

lSs:ii    ..r    si,ii.,    r,..,.i.l    ..t    Health.    IsTT    i    '  :        m.  mi.,  r    I'     S     i'i\il    S.  I  X  n  .     c'ommission, 
lSS:i-l,^,^,'.,      I'l  ..i.-ss..r   Emiretus   of    I'l.liii.,.!    i: ..ni.x.    riu\.nsii,\    ..I     lllin..is.      Author 

of    numerous    peiiafiogl.al    works.       l>ie.l    In    W  ash  i  n^  I.  .1 1,    1  1.    C,    Lletohel     211,    1S9S. 


John  Henry  Ranch,  M.   1). 

JOHX  HENRY  RAUCH,  Chicago;  born  September  4,  1S2S,  Lebanon,  Pennsylvania. 
Graduated  University  of  Pennsvlvania,  lS4i).  Meniher  faculty  Rush  Medical  College, 
Chicago,     1S57-1S60.    "Sanitnrx'     snl ..  i  i  nl  .ni.l.  n  l     oT     i 'li  i.  ,i  i;. .,     1SI;7-1S73.       Chief    medical 

officer   under   General    Gimiii     m    l.n-    T.nin  ,.ii.l    \iiliiiii    i  n  mpnigns.      At    close    of 

Civil    War    he    was    brev.ii..!     I.nni.n, '..[.in.  I     i..i     nniii is    services.      Member, 

president  and  secretary  of   Sini.-    I;..,.i.i    ..i    ll.ilih,    1,^7.-In!i1        i>i.-.l   in   Lebanon,   Penn- 
-sylvania,  March  24,  1S!I4. 

Horace  Wardner,  M.  D. 

IKiIlAi'E  WARDNER,  Cairo;  horn  August  2.t,  1829,  Wyoming  County,  New  Ymk, 
Studied  at  CavuKn  A.ademv  ami  .Mfred  University  and  graduated  in  medicine  fnun 
Rusli  .Medical' «'.. 11.  i;.,  ilinn;;..  in  l^,.r.  r..i;nii  practicing  medicine  at  Libertyville. 
Illinois  in  1S5S.  i;.  itiin..!  i..  ihn.u..  I..  i..i.  ihe  year  was  up  and  opened  a  private 
anattunieal  room  wini.  In  i,in:;lii  nn.ln,.!  ,-iii.liiits.  Elected  member  faculty  Chicago 
Medical  College,  l.s.j;i.  .Suiyeon  12tli  Illinois  Volunteer  Infantry  and  staff-surgeon 
in  Grant's  Tennessee  Army  during  Civil  War.  Brevetted  Lieutenant  Colonel  for 
meritmious  services.  Located  in  Cairo,  Illinois  in  1SC7.  Appointed  superintendent 
Anna  State  Hospital,  1878.     Member  State  Board  of  Health,   1877-1881. 


Dr.  Cadwell  was  a  prominent  citizen  during  tlie 
early  period  of  Illinois  history  and  participated  in 
the  first  efforts  to  secure  laws  relating  to  the  prac- 
tice of  medicine  and  to  public  health. 


PUBLIC  HEALTH  ADMINISTRATION  IN  ILLINOIS. 

'J'hc  uiganizatioii  of  the  Stale  Jloanl  uf  llealth  in  isT^,  niarkb  the  lime 
when  the  conservation  of  the  pnhhc  liealth  was  first  nndertaken  by  the  State 
oi  Illinciis,  and  when  a  department  of  the  State  government  was  first  charged 
with  liiis  fnnction. 

Prior  to  that  time,  the  local  lownsliip  and  numicipal  governments  in 
the  State  had  been  given  the  power,  either  by  special  charters,  or  general 
legislation  such  as  the  Cities  and  \  illages  Act  of  1S7:.!  to  protect  the  public 
health,  in  their  respective  local  communities,  in  some  of  the  larger  cities 
of  the  State,  this  authority  had  been  exercised,  and  local  lioards  of  health 
or  cit\-  physicians  appointed  to  attend  to  this  duty.  Such  action  was  usually 
taken  during  some  epidemic  of  cholera  or  smallpox  and  after  the  danger 
from  the  epidemic  had  passed,  the  sanitary  measures  instituted  lagged,  the 
enthusiasm  of  the  officials  waned,  appropriations  for  the  work  lapsed  and 
were  not  renewed,  with  the  result  Ihal  it  was  discontinued,  only  to  be  re- 
newed again  with  the  next  a])pearance  of  an  epidemic. 

This  was  the  general  history  of  the  local  health  organizations  in  ihe 
State.  Even  Chicago  was  not  an  exception;  there  the  board  of  health  was 
aliolished  as  late  as  1860,  "on  account  of  the  absence  of  any  alarming  con- 
ditions", but  was  reestablished  in  ISii;  when  cholera  had  visited  the  city 
and  smallpox  was  reaching  epidemic  jiroporlions. 

The  local  medical  societies  took  an  active  interest  in  instituting  measures 
for  ihe  protection  of  their  communities  against  pestilential  diseases  and  in 
some  localities  attended  to  this  work,  without  any  form  of  health  organiza- 
tion. Active  members  of  these  societies  often  served  as  members  of  the 
local  boards  of  health.  In  this  work  as  well  as  in  their  jiractice  they  came 
across  the  numerous  unc|ualified  jiersous  who  were  jiracticing  medicine,  be- 
cause as  yet.  there  were  no  laws  t(]  prohibit  this.  It  was  this  state  of  affairs 
that  brought  on  the  movement  which  resulted  in  the  organization  of  the  State 
Hoard  of  liealth. 

Genesis  of  the  Public  Health  Law. 

Public  health  work  as  a  permanent  function  of  the  .^tate  go\ernment 
was  first  established  iij,  Illinois  in  ItSTT.  <  hi  |nl\-  1  of  that  year  two  laws, 
one  known  as  the  State  Board  of  Health  Act  and  the  other  as  the  Medical 
Practice  Act,  became  effective.  The  former  was  aiij>roved  by  the  Ciovernor 
on  May  25  and  the  latter  on  May  2'J,  is:  ;.  Both  laws  had  the  same  ultimate 
purpose  in  view  and  the  State  Board  of  Health,  which  was  organized  on  July 
12  of  the  same  year,  was  charged  with  the   responsibilities  and  duties  in- 

(12:) 


Shelby  Moore  Cullom.  Governor  of  Illinois 
1S77-1SS3,  who  signed  the  first  public  health 
law  enacted  in  the  State  and  the  first  perma- 
nent  law  regulating  the  practice  of  medicine. 


PUBLIC    HEALTH     ADM  I MSTRATIOX  139 

volvfd  ill  the  enforcement  of  both.  This  dual  responsibility  of  regulating 
the  practice  of  medicine  and  promoting  sanitary  and  hygienic  activities  ordin- 
arily referred  to  as  public  health  service  was  a  new  thing  for  a  state  board 
of  health  in  the  United  States,  and  it  provoked  considerable  interest  among 
sanitarians  and  the  medical  profession  throughout  the  country. 

The  passage  of  these  two  public  health  laws  was  not  an  expression 
of  a  sudden  burst  of  enthusiasm  for  more  healthful  conditions  but  rather 
the  belated  fruition  of  an  idea  that  took  root  and  provoked  agitation  among 
the  people,  especially  the  medical  profession  of  Illinois  in  territorial  days 
sixty  years  and  more  before.  Proof  of  this  is  the  fact  that  an  ordinance  or 
law  regulating  the  practice  of  medicine  was  enacted  by  the  territorial  Genera! 
Assembly  in  1817  and  duly  signed  by  Ninian  Edwards  who  was  the  terri- 
torial governor  at  the  time.  Furthermore  the  first  State  General  Assembly 
passed  a  medical  practice  act  in  1819  and  another  was  passed  by  the  General 
Assembly  in  1825.  Both  were  promptly  repealed,  however,  by  the  next  legis- 
lature succeeding  the  enactment.  Bills  introduced  in  later  sessions  of  the 
General  Assembly  failed  to  become  law  until  1877. 

Dual  Co)U-('pfioii  of  FiihUc  HeaJtIi  Worli. 

The  idea  of  public  health  service  as  it  was  finally  expressed  in  the 
first  permanent  statutes  grew  out  of  two  very  definite  conceptions  which 
have  not  always  promoted  harmony  of  action  in  this  field  of  endeavor.  One 
conception  was  and  still  is  that  good  doctors  are  the  dominant  factor  neces- 
sary to  good  public  health  and  to  secure  the  latter  the  state  can  best  function 
by  bringing  about  the  former.  This  idea  was  expressed  very  well  by  Dr. 
Horace  Wardner.  as  president  of  the  State  Board  of  Health  in  isso,  when 
he  said, 

■•Through  the  work  of  the  Board  the  profession  has  deliberately  said  to  the 
people:  'Your  greatest  danger  is  from  ignorance  and  the  iniquity  of  pretending 
physicians,  and  we  have  sought,  and  are  seeking,  to  protect  the  people  at  this 
point,  by  subjecting  the  tjualiflcations  of  all  persons  desiring  to  practice  medicine 
to  reasonable  and  satisfactory  tests;'  " 

and  again  by  a  committee  of  the  State  Board  of  Health  appninted  in  1880  to 

inquire   into   requirements   for  "good   standing"   of   medical   colleges   which 

concluded  that. 

"We  shall  only  fulfill  our  duty  as  a  State  Board  of  Health  by  promoting  to 
the  utmost  that  largest  and  most  potential  force  in  sanitary  science  and  in  public 
hygiene — a  well  trained  and  thoroughl.v  educated  medical  profession." 

The  other  conception  was  and  is  that  sanitation,  quarantine  and  hygiene 
are  things  the  application  of  which  will  produce  significant  results  in  pre- 
serving and  improving  public  health  hexdiul  the  capacity  of  private  medical 
practitioners,  be  the  profession  ever  so  efficient  and  well  trained.  Advocates 
of  this  conception  believed  that  regulating  the  practice  of  medicine  was  in- 


130  I'UliLIC    IIKAI.TII     ADMINISTKATIOX 

cidental  or  subordinalc  to  other  j)ul)lic'  lii'alth  futictit)iis  of  the  Siatu.     A  yno.l 

expression  of  this  conception  is  found  in  a  paper  read  Ijy  Dr.   I'"..  W".  ( .ray 

of   Bloomington,  hefore  the   Ilhnois   State   Medical   Society   in    May.    ls:(), 

which  reads : 

"The  people  need  to  be  enlightened;  they  need  to  be  directed:  in  many  cases 
they  need  to  be  restrained.  A  board  of  health  organized,  and  provided  with  means 
to  collect  information,  and  diffuse  among  the  people  a  better  knowledge  of  the 
laws  of  health,  and  to  discover  to  them  the  dangers  to  which  they  are  exposed, 
would  save  thousands  of  poor  victims  from  untimely  death."  ' 

The  "good  doctors"  conception  is  much  the  older.  It  was  the  only  one 
expressed  in  the  territorial  law  of  ISH.  In  the  law  of  ISli)  a  section  re- 
quired the  reporting-  of  hirths,  deaths  and  diseases  Imt  otherwise  it  was 
concerned  only  with  providing  "good  doctors."  The  \><2'i  law  was  con- 
cerned with  nothini:;  but  the  regulation  of  the  practice  of  medicine.  Dr. 
George  t/aduell,  a  ])rominent  and  useful  citizen  who  came  into  Illinois  he- 
cause  of  his  bitter  animosity  toward  slavery,  championed  the  law  of  LSI!) 
while  Dr.  Conrad  Will  was  the  moving  spirit  behind  the  act  of  \x2o.  Dr. 
George  Fisher  was  Speaker  of  the  House  of  the  territorial  .\sseml)ly  in  IS  17 
and  presumably  had  considerable  t<i  do  with  the  law  enactetl  then. 

In  isr](;  and  again  in  18(11  a  connnittee  was  appointed  b_v  the  Aescu'a- 
pian  Society  of  the  Wabash  Valley,  which  had  originally  been  organized  in 
184G  as  the  Lawrenceville  Aesculapian  Society,  to  go  before  the  State  legi.s- 
lature  asking  for  a  law  creating  a  State  Board  of  Health  to  regulate  the  prac- 
tice of  medicine  and  to  collect  birth  and  death  certilicates.  15(>th  attem])ts 
failed  to  produce  the  desired  results.  Very  likely  the  matter  was  agitated 
and  brought  before  the  General  Assembly  at  other  times  during  the  fifty  year 
period  between  1827  and  1877. 

The  "good  doctors"  conception  was  revived  by  the  Jersey  County  Med- 
ical Society  in  a  communication  addressed  to  the  Illinois  State  Medical 
Society  and  read  before  that  organization  at  its  annual  meeting  in  May,  187G. 
It  advocated  the  organization  of  a  State  Board  of  Health  for  the  purpose 
of  regulating  the  practice  of  medicine  and  of  collecting  statistics  of  births 
and  deaths.  This  communication  was  an  important  factor  in  crystalizing 
sentiment  which  resulted  a  year  later  in  the  Medical  Practice  Act  of  187;. 

It  was  not  until  after  the  Civil  \\'ar  that  the  sanitary  and  hygienic  con- 
ception began  to  take  root  in  this  country.  There  is  record  of  four  meet- 
ings known  as  Xatioiial  Sanitary  Conventions  which  were  held  in  1S.")7,  1S.")8. 
185'J  and  iscd  in  Philadelphia,  Baltimore,  New  York  and  Baltimore  but 
these  were  abandoned  with  the  outbreak  of  hostilities  and  nothing  f  mi  her 
was  done  on  a  nation.al  scale  mitil  is;-.'  when  the  .\merican  Pn'nlic  Health 
Association  was  onj.ani/.ed. 


Sl;ite  Mertii-al   Snrioty,    1S7G. 


PUBLIC    HEALTH     ADM  I MSTKATION  131 

The  very  first  public  utterances  on  sanitation  as  an  important  factor  in 
healthfulness  took  place  in  this  country  about  ISoO  when  Lemuel  Shattuck 
published  lii>  report  on  sanitary  conditions  in  Massachusetts.  It  was  1S57 
before  I'asteur.  wcjrking  in  France,  published  his  first  report  which  opened 
up  the  field  of  bacteriology  and  it  was  ten  years  later  before  Lister,  the  cele- 
brated English  physician  and  pupil  of  I'asteur,  began  to  attract  public  notice 
by  his  great  success  in  the  [jractice  of  antiseptic  surgery.  Prior  to  Pasteur 
and  Lister,  whose  work  related  to  bacteriology,  was  the  German,  Max  von 
Pettenkoft'cr,  founder  of  modern  hygiene,  lie  it  was  who  recognized  more 
fully  than  had  ever  before  been  recognized  that  health  is  impaired  by  factors 
not  in  ourselves  lint  in  our  environment.  This  a])ostle  of  cleanliness  was 
prominent  enough  in  ISCi.")  to  be  appointed  head  of  ihe  first  institute  for  the 
study  of  hyL;iene  which  in  that  year  was  inaugurated  at  the  L'niversity  of 
.Munich.  It  was  doubtless  the  works  of  this  man  that  stinuilated  the  first 
agitation  in  .\merica  for  sanitation  as  a  public  health  activity.  Bacteriology 
developed  later  and  began  to  be  apjireciated  on  a  significant  scale  in  this 
countiy  toward  the  closing  \Tars  of  the  nineteenth  century. 

I'lorn  in  luiro|)e  and  finding  ready  disciiiles  along  the  Atlantic  seaboard 
in  this  country  the  new  ideas  of  samtar_\'  control  over  diseases  began  rapidly 
t(]  lilter  into  Illinois.  Dr.  John  W.  Ranch  of  Chicago  manifested  interest 
enough  in  the  new  movement  to  attend  the  organization  meeting  of  the 
American  Public  i  lealth  .\ssociation  which  took  place  in  New  York  on 
April  IS.  l,s;->.  By  ISTti  Dr.  E.  W.  (iray  of  Bloomington  had  become 
enthusiastic  enough  to  prepare  a  paper  on  the  sul.)ject  addressed  to  the  people 
of  the  State,  which  he  read  before  the  annual  meeting  of  the  Illinois  State 
Medical  Society  in  May.  In  thi>  |japer  Dr.  (iray  advocated  the  establish- 
ment of  a  State  Board  of  1  lealth.  .\s  .a  result  of  this  pajier  he  was  ajipointed 
chairman  of  a  comnn'ttie  to  memorialize  the  legislature  on  the  Miljject  of  a 
state  bo.ird  oi  health.  That  the  work  of  this  committee  was  crowned  with 
success  shows  that  Dr.  (iray  and  his  colleagues  carried  their  enthusiasm  for 
sanitation  to  pr;ictical  account. 

While  both  the  "go(jd  doctors"  and  "sanitation"  conceiitions  of  public 
health  ser\ice  pie\aile<l  among  the  medical  profession  the  majority  of  opinion 
favored  the  former.  The  latter,  however,  appealed  to  the  legislature  strongly 
enough  to  bring  forth  a  law  creating  the  State  Board  of  Health  to  which  was 
incidentally  delegated  the  power  to  regulate  the  practice  of  medicine.  Indeed, 
provision  was  made  in  the  Medical  Practice  .\ct  for  another  tv]je  of  admin- 
istrative m.achinery  and  the  Board  of  llealth  fell  heir  to  that  duty  as  ;i  result 
ol  the  success  of  the  s.anitarv  law. 

This  dual  conception  concerning  public  health  service  was  important. 
It  exercised  a  i)rofoi\n(l  infiuence  t)ver  the  functions  of  the  State  Board  of 


132  I'l'IiMC    HF.ALTII     ADMIMSTKATIOX 

Health;  it  also  exercised  a  profound  iiiHueiice  over  the  relalidiis  between  the 
medical  profession  and  the  State  health  authorities. 

As  a  result  of  the  conmuniication  from  the  Jersey  County  Medical 
Society  and  the  paper  liy  Dr.  (Ivay  the  Illinois  State  Medical  Society  passed 
the  following  resolution  ; 

"Rt'solvpcl. — That  a  Committee  be  appointed  to  memorialize  tlie  next  legisla- 
ture on  the  subject  of  the  appointment  of  a  State  Board  of  Health:  and  that  with 
proper  modifications,  the  act  by  which  the  Board  of  Health  of  Massachu-setts  was 
inaugurated  be  submitted  to  the  same  as  a  basis  for  the  Illinois  State  Board. 

"Rc.iolvrd. — That  as  members  to  the  State  Medical  Society,  each  one  shall 
consider  himself  bound  to  urge  the  propriety  of  a  State  Board  of  Health  upon  the 
i-epresentative  from  his  district." 

This  niovenient  led  directh'  to  the  enactment  of  the  ?vledical  Practice  and 
Slate  Hoard  of  Health  laws  in  is;7  which  vested  in  one  body  the  attthoritv 
and  duties  prescribed  bv  both. 

I'rciponents  of  the  "good  doctors"  conception  knew  exactly  what  they 
wanted.  Thus  the  Medical  Practice  Act  was  very  definite,  specifying  what 
should  and  what  should  not  be  done  tinder  its  provisions,  giving  the  admin- 
istrative agency  reasonable  discretion  on  technical  points. 

I'rorisloiis  licUilniii  in  Saml ai laii. 

.Vdvocates  of  sanitation  had  little  of  a  tangible  nature,  except  the  de- 
sire for  vital  statistics,  which  the}'  could  recommend  in  language  that  the 
average  legislator  could  understand.  Accordingly  the  first  public  health  law- 
grants  to  the  State  Board  of  Health  the  following  powers : 

"The  State  Board  of  Health  shall  have  general  supervision  of  the  interests  of 
the  health  and  life  of  citizens  of  the  State.  They  shall  have  charge  of  all  matters 
pertaining  to  quarantine;  and  shall  have  authority  to  make  such  rules  and  regu- 
lations, and  such  sanitary  investigations  as  they  from  time  to  time  may  deem 
necessary  tor  the  preservation  or  improvement  of  public  health,  and  it  shall  be 
the  duty  of  all  police  officers,  sheriffs,  constables,  and  all  other  officers  and  em- 
ployes of  the  State,  to  enforce  such  rules  and  regulations,  so  far  as  the  efflcieucy 
and  success  of  the  Board  may  depend  upon  their  official  cooperation." 

This  is  the  second  of  the  fourteen  sections  of  the  original  State  Hoard 
of  Health  .\ct  and  it  is  the  only  section  that  deals  with  sanitation  or  hygiene. 
Six  of  the  sections  deal  with  vital  statistics  and  the  remainder  with  incidental 
matters  relating  to  penalties,  technique  of  the  P>oar(rs  procedures.  a]ipropria- 
tit}ns.  etc. 

The  sweeping  authority — "i^enera!  ■-uiierxi^ion  of  the  interests  of  heaUh 
and  life  of  citizens"  and  "authority  to  make  ■'Ucli  ru'e>  and  regulations  and 
such  sanitarv  investigations  a>  they  from  time  to  time  may  deem  necessary 
for  the  preser\;uioii  and  improvement  of  jutblic  health" — granted  to  the 
State  Hoard  of  I  K-;dth  in  the  original  law  was  a  recognition  liy  the  legislature 
that  public  lualtb  work  is  highly  technical  in  cb.aracter  and  requires  specially 
trained  personnel.     I-'rom  this  position  the  lawmakers  have  never  retracted 


ri'BLlC    HEALTH     ADMINISTRATION  133 

SO  that  ihe  laws  are  still  bniad,  niakini;  the  rules  nf  the  present  State  health 
organization  tantanmunt  to  law.  Time  and  ai;ain  from  the  very  outset  the 
State  health  offieials  ha\'e  found  it  eiin\enient  and  necessary  to  initiate  activ- 
ities oi  an  arbitrar\-  character  under  the  authority  granted  in  this  generalized 
section  and  the  courts  have  generally  ui)liekl  these  measures. 

It  will  be  seen  that  the  compromise  of  the  General  ;\.ssembly,  which 
vested  in  one  board  the  powers  and  duties  representing  two  distinct  scIkkiIs 
of  thought  was  not  destined  to  unite  and  harmonize  the  two  and  that  even 
a  State  Board  of  Health  cannot  serve  two  masters.  Ultimately  the  State 
Board  of  Health  lost  its  identity  as  an  integral  part  of  the  State  government 
and  in  its  place  were  created  two  departments,  the  one  to  devote  its  full 
energy  and  resources  to  sanitary  and  hygienic  activities  and  the  other  to 
regulate,  among  other  things,  the  practice  of  medicine. 

Development  of  State  Health  Service. 

Three  Periods. 

State  public  health  service  in  Illinois  falls  conveniently  into  three  r.'ither 
well  defined  periods.  The  first  ended  with  the  century  in  IDOO,  It  may  be 
described  as  a  sort  of  probationary  exjjerience  for  the  State  ooard  of  1  lealth. 
During  that  time  the  State  health  organization  was  on  trial,  so  to  speak. 
It  faced  the  problem  of  justifying  its  existence.  Governors  and  lawmakers 
suffered  it  to  continue  through  a  sort  of  kindly  tolerance.  They  were  never 
warmed  with  sufficient  enthusiasm  for  this  new  venture  to  unlock  the  treas- 
urv  vaults  for  its  benefit.  The  first  appropriation  was  $.'J()()U  for  the  bien- 
nium.  For  the  last  fiscal  year  of  the  century,  ended  Jtuie  30,  1899,  the  appro- 
priation to  the  State  Board  of  Health  for  ordinary  expenses  was  $9250.  A 
contingency  fund  of  $10,000  was  available  to  draw  on  under  specified  condi- 
tions during  a  number  of  years  in  this  period  but  those  conditions  rarely 
arose — at  least  not  in  the  opinion  of  the  Governor  whose  judgment  in  the 
matter  was  a  lock  on  the  purse  strings. 

The  second  period  started  out  with  the  new  century  and  terminated  in 
mil.  For  the  State  Board  of  Health  these  years  may  very  properly  be  called 
the  period  of  expansion  and  recognition.  In  1901  the  legislature  approjjri- 
ated  a  sum  of  S-1.J,300  per  annum  for  expenditure  through  the  State  Board 
of  Health.  For  the  fiscal  year  ended  June  30,  liMl,  the  available  apjiropria- 
tion  amounted  to  $l(iri.."iS9.  Alanifestly  the  people  of  the  State  and  the 
legislature  found  in  ihe  State  P.oard  of  Health  something  for  which  they 
were  willing  to  ]jay  considerably  more  than  had  been  the  case  twenty-five 
years  before.  The  1901  appropriation  amounted  to  ^t^'.t  ])er  1000  persons  per 
year  while  that  drawn  upon  for  the  fiscal  year  ending  June  Mi),  lull,  amount- 
ed to  nearly  $2.').     The  changes  that  took  place  in  the  amount  of  mone\   made 


134  I'l^BLIC    HEALTH     ADMINISTRATION 

available  lor  health  service  make  a  good  measure   for  the  amount  of  ])ublic 
interest  in  that  work  during  those  years. 

The  third  and  last  period  to  date  began  with  the  adoption  of  the  Civil 
Administrative  Code  by  the  Illinois  state  government  and  continues  to  this 
writing  in  1!)2T.  It  is  called  the  period  of  maturity  not  in  the  sense  that  the 
State  public  health  organization  represents  what  might  be  considered  a  ma- 
ture or  adecjuate  agency  for  combating  disease  and  promoting  health  to  the 
fullest  practicable  extent  under  present  condition^  but  rather  in  the  sense 
that  it  now  is  regarded  as  an  essential  factor  in  the  State  government  and 
functions  on  a  jjlane  commensurate  with  that  of  any  other  department.  The 
dominant  characteristic  of  this  period  is  the  divorcement  in  practice  of  the 
"gooil  (ioclor>"  from  the  "sanitation  and  hygiene''  conception  of  public  health 
service,  r.oth  contiiuie  to  be  important  activities  of  the  State  administra- 
tion but  all  matters  relating  to  the  registration  of  physicians  and  regulation 
of  medical  ])ractice  repose  in  the  State  Department  of  Registration  and  Edu- 
cation, while  those  concerned  with  sanitation,  hygiene  and  vital  statistics  are 
in  the  hands  of  tiie  Slate  I  )e]);irtnient  of  Public  Health. 

Four  PcrsdiKilifics. 

The  three  ]x-riods  of  development  of  the  public  health  machinery  in  the 
State  are  dominated  by  four  personalities.  About  each  of  these  revolve  the 
policies,  the  character  and  the  color  of  the  State's  participation  in  public 
health  service  during  the  period  in  which  each  was  active.  Each  made  sig- 
nificant contributions  to  the  [lublic  health  movement  in  Illinois. 

The  first  of  the  four  was  Dr.  John  H.  Ranch,  moving  s])irit  in  the 
period  of  "probation."  As  his  contribution  he  coni])leteIy  justified  the  exist- 
ence of  a  State  public  health  service.  l-"ew  men  have  even  accomplished  so 
much  with  such  meagre  resources.  Blessed  with  a  rare  faculty  for  organiz- 
ing, driven  by  an  overwhelming  enthusiasm  for  getting  things  done,  guided 
by  a  wealth  of  meilical  and  sanitary  information  which  a  passionate  curi- 
ositv  led  him  to  sei'k.  balanced  by  a  ca])acity  for  sound  judgment  and  endowed 
with  tact 'and  diplomacv  Dr.  Ranch  literallx'  ni;ide  the  public  heilth  service 
of  his  time.  A  disci])le  of  sanitation  ami  hygiene  he  also  had  a  ])rofound 
belief  in  the  importance  of  good  doctors  so  that  under  his  influence  the  dual 
functions  of  the  State  P.oard  of  Health  jmigressed  harmoniously  during  the 
fourteen  years  of  his  service  and  carried  over  for  several  years  afterward. 
The  "probationar\"  period  might  very  properly  be  called  the  "Ranch"  period. 
Dr.  Ranch's  name  will  appear  frequently  on  pages  to  follow  that  relate  to 
the  early  health  machinery  of  the  State. 

The  second  in  chronological  order  of  the  four  jiersonalities  was  Dr. 
lames  A.  Egan.  lie  became  the  executive  secretary  of  the  State  Hoard  of 
Health  in  189"  and  belongs  to  and  was  largely  responsible  for  the  "period 


PUBLIC    HEALTH     AUM INISTRATIOX  1-^5 

of  recognition."  Money  getting  was  his  unique  contribution  to  the  jiuhlic 
health  machinery  of  the  State  government.  Before  Egan's  time,  $l-4 .()()()  per 
year,  besides  a  contingency  fund,  was  the  largest  appropriation  that  the  leg- 
islature ever  granted  to  the  State  Board  of  Health.  The  last  General  Assem- 
bl\-  to  meet  during  Egan's  tenure  appropriated  $120, G25,  besides  a  conting- 
ency fund,  for  annual  expenditure  by  the  State  Board  of  Health.  As  an 
opportunist.  Dr.  Egan  took  advantage  of  the  phenomenal  developments  in 
sanitary  and  medical  sciences  that  were  taking  place  immediately  before  and 
during  his  time  and  turned  them  to  good  account  for  public  health  service  in 
the  State.  Based  upon  highly  scientific  knowledge,  successful  ptiblic  health 
services  requires  highly  trained  technical  personnel  and  this  requires  money. 
Dr.  Egan  made  a  splendid  contribution  to  public  health  service  in  Illinois, 
when  he  got  the  legislature  in  the  habit  of  granting  significant  apjjropriations 
to  the  State  Board  of  Health. 

The  third  of  the  four  personalities  was  Dr.  C.  St.  Clair  Drake.  He 
became  the  executive  officer  of  the  State  public  health  organization  in  l'-)H 
and  continued  until  1921.  His  tenure  was  therefore  partly  in  two  of  the 
major  periods.  By  nature  a  propagandist,  in  the  best  meaning  of  that  term, 
Dr.  Drake  poptilarized  public  health  work  in  the  State.  He  was  a  man  who 
radiated  enthusiasm.  Endowed  with  a  resourceful  imagination,  he  managed 
to  create  ingenious  mechanical  models  that  carried  fundamental  public  health 
messages  into  every  part  of  the  State.  This  exhibit  material  which  was  suf- 
ficient to  fill  one  thousand  square  feet  of  display  space  was  in  demand  at 
local  fairs  everywhere  and  it  never  failed  to  command  attention  and  it  left 
indelible  impressions  upon  those  who  saw  it.  Furthermore,  Dr.  Drake  in- 
itiated the  Better  Baby  Conference  movement  in  Illinois.  He  developed  a 
motion  picture  library  from  which  health  films  are  circulated  in  the  State. 
He  inaugurated  the  "Health  Promotion  Week"  idea  that  has  come  to  be  an 
annual  event  and  one  that  has  always  attracted  wide  attention  and  a  fine 
response.  Under  Dr.  Drake  the  State  Board  of  Health  was  reorganized  into 
the  State  Department  of  Public  Health  and  it  was  Dr.  Drake  who  drew 
up  the  plans  of  organization  which  still  characterize  the  Department.  This 
movement,  however,  was  initiated  by  Governor  Lowden  in  his  Civil  Ad- 
ministrative Code  scheme  and  was  only  incidentally  a  part  of  Dr.  Drrike's 
achievements.  Dr.  Drake  was  primarily  a  publicity  expert.  His  donation 
was  an  educative  method.     He  popularized  public  health  activity. 

Dr.  Isaac  D.  Rawlings,  appointed  in  1921  as  Director  of  the  State  De- 
partment of  Public  Health  and  the  last  of  the  four  personalities  brought 
system  into  the  service.  Vital  statistics  were  far  from  satisfactory,  and 
had  been  a  bane  to  State  health  officers  since  the  days  of  Ranch.  .Mor- 
tality returns  were  complete  enough  to  be  acceptable  to  the  United  States 


136  ITin.lC     JIEALTII    ADMINISTRATION 

bureau  of  the  census  but  no  compilations  or  analyses  of  consequence  were 
made  by  the  State  registrar  before  his  coming.  Birth  reports  were  too  in- 
complete to  meet  the  federal  requirements  for  recognition.  Dr.  Rawlings 
went  methodically  about  the  task  of  improving  vital  statistics,  arranging 
for  every  division  of  the  Department  to  cooperate  to  that  end  so  that  within 
eighteen  months  Illinois  had  been  admitted  to  the  United  States  birth  regis- 
tration area  and  fairly  satisfactory  annual  compilations  were  forthcoming 
from  the  State  registrar.  Under  Dr.  Rawlings,  regular  staft  meetings  of 
division  heads  were  started,  the  first  board  of  public  health  advisors  was 
appointed  and  met  regularly,  a  central  filing  system  of  Department  cimi- 
munications  was  installed,  the  official  bulletin  was  established  on  a  monthly 
basis  in  fact  as  well  as  in  name,  newspaper  publicity  w^as  supplied  regularly 
each  week  to  the  press  of  the  State,  a  scheme  of  supplying  local  health  offi- 
cers w-ith  weekly  morbidity  reports  was  established,  the  method  of  record- 
ing morbidity  reports  was  simplified  and  made  much  more  serviceable,  the 
routine  investigation  of  every  reported  case  of  typhoid  fever  and  smallpox 
was  started — in  short  the  work  of  the  Department  was  systematized. 

Each  of  these  four  sanitarians  did  other  important  public  health  serv- 
ices. Other  executives  of  the  State  public  health  organization  accomplished 
many  things  of  importance  and  value.  Justifying  the  existence  of  a  board 
of  health,  wringing  money  from  a  skeptical  legislature,  popularizing  health 
on  a  large  scale  and  systematizing  the  public  health  service  are  the  larger 
achievements  that  have  marked  the  progress  of  officially  organized  pre- 
ventive medical  activities  in  Illinois  and  for  these  significant  contributions 
Ranch.  Kgan.  Drake  and  Rawlings  were  respectively  responsible. 

State  Health  Machinery. 

Rarely  may  one  find  in  history  circumstances  more  favorable  to  the 
launching  of  a  great  public  health  movement  than  those  w'hich  prevailed 
in  Illinois  in  the  "seventies".  The  severe  losses  of  the  Civil  War  in  which 
disease  caused  far  greater  mortality  than  shot  and  shell  was  still  fresh 
in  the  minds  of  men  and  especially  in  the  memory  of  the  medical  pro- 
fession. Disastrous  waves  of  cholera  had  swept  the  country  in  lS.j-3  and 
1867.  Highly  fatal  and  widespread  epidemics  of  diphtheria  and  scarlet  fever 
came  and  went  with  the  seasons  while  helpless  communities  sat  grimly 
by  until  the  infections  burned  themselves  out  by  natural  limitations.  Ty- 
phoid fever  was  frightful,  frequently  striking  whole  families  simuitaneously. 
Yellow  fever  broke  out  periodically  in  the  lower  Mississippi  Valley  and  was 
a  perennial  source  of  paralyzing  fear  to  the  citizens  of  Illinois.  Immigration 
into  the  State  from  abroad  was  very  heavy,  establishing  dangerous  contact 
with  European  foci  of  smallpox,  cholera  and  other  infections  that  often  in 


PUBLIC    HEALTH     ADM  I MSTKATION  ]  li? 

that  day  cleijopulated  great  areas  of   land,  especially   in    foreign   Cduntries. 
Quackery  was  rampant  in  the  State  because  the  field  was  fruitful. 

On  the  other  hand  an  awakening  to  the  possibilities  of  preventing  and 
controlling  communicable  diseases  through  sanitation  and  hygiene  was  be- 
ginning to  manifest  itself  here  and  there  among  research  workers.  P"or- 
ward  looking  members  of  the  medical  profession  and  others  in  Illinois  were 
already  beginning  to  appreciate  the  significance  of  what  Pettenkoffer.  Pas- 
teur and  Lister  were  doing  aliroad.  \'accination  as  a  preventive  against 
small])Ox  was  an  estaljlished  medical  procedure. 

BdunJ  of  Ifcdill/  Orfiaii'iK  (1. 

If  the  time  was  oppiirtuiu'  the  members  of  the  first  State  Board  of 
Health,  ajtjjointed  liy  Governor  Culldm  were  e(iual  to  the  occasion  and  fully 
worthv  of  the  confidence  and  trust  rejiosed  in  them.  Thev  were  Newton 
Bateman,  LL.  D.,  of  Galesburg.  intimate  friend  of  Abraham  Lincnln  and 
an  eminent  educator  and  author,  president  of  Knox  College  at  the  time 
of  appointment;  Reuben  Ludlam,  M.  D.,  of  Chicago,  dean  of  the  faculty 
of  Hahnemann  College  and  author  of  numerous  medical  treatises;  Anson 
L.  Clark,  M.  D.,  of  Elgin,  assistant  surgeon  in  the  Cnion  Army,  moving 
spirit  in  the  organization  of  Bennett  Medical  College  of  which  he  was 
president  for  many  years,  president  of  a  number  of  medical  organizations 
and  member  of  the  Elgin  Board  of  Education  ;  William  Al.  Chambers.  Al.  D., 
of  Charleston,  brigade  surgeon  in  the  Union  Army  where  he  was  brevetted 
Lieutenant  Colonel  and  Colonel  successively  for  meritorious  services,  jiresi- 
dent  of  a  number  of  medical  organizations  and  member  of  the  American 
Public  Health  Association ;  John  Milton  Gregory,  I^I^.  D.,  of  Champaign, 
ordained  minister  of  the  Baptist  faith,  eminent  educator  and  author  and 
many  times  commissioned  by  state  and  federal  governments  to  fill  important 
posts  at  home  and  abroad  and  president  of  Illinois  Industrial  University 
at  time  of  appointment;  John  H.  Ranch,  M.  D.,  of  Chicago,  highest  rank- 
ing medical  director  on  General  Grant's  staff  in  the  Army  of  Tennessee,  chief 
of  the  medical  staff  under  U.  S.  Grant  in  his  Virginia  campaigns,  sanitary 
superintendent  for  the  board  of  health  in  Chicago ;  Horace  Wardner,  M.  D., 
of  Cairo,  assistant  medical  director  on  General  Grant's  staff  in  the  Army  of 
Tennessee,  member  of  faculty  of  Chicago  Medical  College,  While  not  a 
member  of  the  Board,  Dr.  Elias  W,  Gray  of  Bloomington,  who  had  partici- 
pated in  the  Civil  War  as  an  assistant  surgeon,  was  elected  the  first  executive 
secretary  of  the  Board. 

First  Jpjiiojiriafiniis. 

With  an  .-qiprojiriation  of  $.j,()OO.U0  for  the  first  liiennium  and  author- 
ized to  spend  moneys  collected  for  license  fees  al   the   rate  of  -tl.Dd  each 


KiS 


ITlil.lC     IIKALTIl     ADMINISTRATION 


from  practilidiKTs  lidliliiis^  hoiia  lidc  (liplonias  and  •$."). 00  each  from  those 
wild  had  to  In-  L-.\amiiK-d,  the  State  lioanl  of  Hcahh,  duly  organized  on 
luly  \'i.  l^^i  wiih  Dr.  Ranch  as  president,  set  itself  energetically  to  regu- 
lating the  practice  of  medicine — the  most  olnious  t;isk  at  hand. 


ORGAniZATlOn    OF 

STATE  BOARD  OF  HEALTH 

1677 

STATE  BOARD  OF  HEALTH 

7     Members 

Members   participatinq  in 
the  enforcement  ot  riedicaK 
Practice  Act   with  aid  ot  extra 

1 
1 

Clerical   Service 

2    Clerks 

1    Executive  Secretary 

Vw..  N.    Woi'kint;  strength  (if  tlie  lirst  SUite  health  organization. 

/''//■,s7   Jrlirillrs. 

During  the  lirsi  six  months  of  its  existence  the  memhers  of  the  Board 
of  Health  and  it^  executi\e  secretary,  with  very  limited  clerical  assistance, 
made  u].}  the  entire  strength  of  the  State's  puhlic  health  organization.     The 


PUBLIC    HEALTH    ADMIXISTUATIOX  131) 

iiiagnituile  of  the  job  of  certifying  doctors  and  the  extreme  meagerness 
of  resources  practically  prohibited  any  signilicant  attention  to  sanitary  and 
hygienic  matters.  Presumably  chafing  under  what  he  regarded  as  a  neg- 
lect of  its  sanitary  duties  by  the  Board,  Dr.  Gray  resigned  as  secretary  on 
December  20,  1S7  7.  In  accepting  his  resignation  the  Board  emi)hasized  its 
appreciation  of  Dr.  Gray's  interest  in  sanitation.  Dr.  Ranch  acted  as  secre- 
tary from  December,  187;  until  May,  IS^S.  Then  Dr.  Clark  was  secre- 
tary for  about  a  year.  Dr.  Ranch  then  became  secretary  again  in  .\pril 
1S7U  and  served  continuously  in  that  cajiacity  until   Is;)]. 

At  the  beginning  the  resources  of  the  State  Board  of  Health  were 
its  own  membership;  such  help  as  it  could  afford  to  enii)l(iy  with  the  sums 
appropriated  by  the  legislature  plus  suius  collected  from  aiiplicants  fur  li- 
cense ;  all  police  officers,  sheriff's  and  constables  who  were  required  b\'  law 
to  enforce  the  rules  and  regulations  of  the  State  Board  of  Health  in  so  far 
as  success  depended  thereon;  vnUmtary  assistance  from  interested  citizens; 
the  National  Board  of  Health;  such  assistance  as  might  be  derived  from  in- 
terstate voluntary  agencies;  such  active  support  as  it  was  alile  to  secure 
from  comiuercial  and  industrial  interests  indirectly  through  legal  authority 
to  (juarantine.  etc. 

The  Rai^cii     Rkgime. 

Dr.  Ranch's  amazing  ability  to  utilize  these  resources  to  a  remarkable 
degree  constitutes  the  story  of  public  health  service  in  Illinois  for  the  first 
fifteen  years  after  its  foundation.  The  legislature  was  never  generous  in 
providing  funds.  That  body  deemed  it  wise  to  clothe  the  Board  of  Health 
W'ith  extensive  power  and  a  small  purse,  h'or  the  first  two  years  it  allowed 
$5000  plus  fees  collected  by  the  Board  which  amounted  to  less  than  $15000. 
For  the  next  four  years  the  appropriations  amounted  to  $5500  per  year  ex- 
clusive of  a  standing  contingency  fuml  nf  $5()()()  that  cfiuUl  be  used  imly  in 
the  face  of  .serious  epidemic  outlireaks.  In  I.SS5  the  legislature  granted  the 
Board  $9000  ])er  year  for  the  ordinary  expenses  and  the  usual  $5000  con- 
tingency. For  the  next  two  years  the  apjjropriation  soared  to  $2-1,000  for 
the  biennium  and  a  $40,000  contingency  fund.  This  liberality  was  actuated 
by  fear  of  a  cholera  epidemic.  When  the  outbreak  failed  to  materialize  the 
annual  grant  fell  again  to  $9000  but  with  the  annual  $20,000  contingency 
remaining.  In  1889  the  appropriations  made  for  the  ensuing  biennium  were 
$9000  per  year  for  ordinary  expenses  and  $5000  per  year  for  emergency  use. 

The  money  appropriated  during  this  period  was  scarcely  enough  to  pay 
the  necessary  expenses  involved  in  collecting  and  compiling  vital  statistics 
and  in  meeting  the  expenses  of  the  P)oard  which  met  as  often  as  thirteen 
times  in  one  year  for  the  convenience  of  those  who  wished  to  be  examined. 


SECRETARIES 

lliaoLS  State  Boacd    of   Hcaltli 


Ellas  ^  Gray.  m.D. 


JohixH.UaucK/m.D. 


AnsoaLClack.m.D. 

ji/jTS'  1S7S  --.^PK-mp 


\Viiv.R.7ll^Keii3UL,m.D. 

^U(S.  4.1391    -    iSPTa-f.  ISi>l 


No  photosraph  of  Dr.  Cray  was  available. 


PUBLIC    HEALTH    ADM  IXISTRATIOX  141 

Dr.  Rauch  was  ambitious  to  raise  the  standard  of  medical  practice  to  the 
highest  possible  level.  He  was  no  less  an.xious  to  put  into  operation  every 
possible  sanitary  and  hygienic  measure  calculated  to  prevent  and  control  dis- 
ease. Too  energetic  and  resourceful  to  allow  the  lack  of  funds  to  thwart  him 
in  his  purpose  he  set  about  \\-ringing  from  the  other  resources  at  his  c(jm- 
mand  every  ounce  of  activity  and  ciKipL'ratinn  which  was  available. 

General  J'ieic  of  P  roll  (in. 

It  will  be  well  to  bear  in  mind  that  Dr.  Rauch  looked  at  sanitary  prob- 
lons  from  a  national  and  even  a  world  ])oint  of  view.  He  would  have 
gloried  in  the  League  of  Nations  because  of  its  possibilities  as  an  interna- 
tional health  agency.  He  recognized,  from  a  sanitary  standpoint,  no 
political  lines  of  demarkation  but  only  the  great  boundaries  established  by 
nature  herself — the  great  oceans  that  .separate  whole  races  of  people.  He 
had  a  passion  for  inaugurating  such  things  as  immigrant  inspection  service 
at  the  ports  of  entry  and  for  the  requirement  of  a  clean  bill  of  health  as  an 
essential  factor  in  a  "passport"  from  abroad.  "Concert  of  action"  was  a 
phrase  dear  to  his  heart  and  furnished  the  basis  for  most  of  his  achieve- 
ments. Perhaps  his  national  point  of  view  was  too  far  reaching  to  be  appre- 
ciated by  the  average  State  legislator  and  maybe  that  explains  to  some  de- 
gree his  inability  to  secure  adequate  appropriations  for  the  execution  of  his 
plans.  Even  when  he  succeeded  in  alarming  the  lawmakers  about  the 
dangers  from  Asiatic  cholera  in  18ST  the  stupendous  grant  of  $40. (KH)  was 
so  guarded  with  contingent  clauses  that  it  was  not  available  for  any  practic- 
able purpose. 

Collecting  vital  statistics  was  the  problem  that  led  the  State  Board  of 
Health  first  to  connect  itp  with  the  State's  health  machinery  resources  out- 
side of  its  own  immediate  organization.  In  the  law  county  clerks  were  re- 
quired to  collect  certificates  of  births  and  deaths  and  to  make  returns  to  the 
State  Board  of  Health.  The  Board  put  the  cotmty  clerks  to  work  on  this 
job  in  the  first  year  of  its  existence  so  that  at  the  end  of  twelve  months  the 
functioning  State  health  machinery  consisted  nl  the  .State  15oard  of  Health, 
which  had  met  13  times,  and  the  comity  clerks,  .Small  sums  had  been  spent 
fur  the  laboratory  examination  of  drinking  water  su])]>lies.  In  a  few  places 
local  boards  of  health  had  been  organized  under  the  Cities  anj  X'illages  Act 

of  is;2. 

(Jiithr((ik    (if    YeUdiv    Fcicf    Siails    Macliincri/    far    ('(nilidl    of 

E iii(l(  lines. 

I)arl<  clouds  of  epidemics  and  rumors  of  epidemics  of  yellow  fever, 
.Asiatic  cholera  and  smallpox  began  to  hover  above  the  health  horizon  in 
the  ^nmmer  of   1ST8  and  the  yellow   fever  thre.it  actually  materialized  into 


142  mii.ic  iii:.\i.Tn  ad.m  inistkatiox 

:i  disastnnis  cuitlircak  that  worki-il  its  way  ii])  the  Mississippi  Valley  as  far 
north  as  llhinii-..  invading  C'aini.  'IIk'sc'  amditions  concentrated  the  thought 
ol  hralth  ciflicials  everywhere  upon  sanitary  matters.  In  Illinois  the  State 
r.uard  (if  I  iealth  wanted  U>  make  the  ])remises  of  every  household  clean  and 
drv.  It  wanted  tii  make  every  puhlie  and  private  water  supply  safe  for 
diinkin';.  Ii  wanted  everv  iiersnn  in  the  State  vaccinated  against  smallpox. 
Il  wanted  ever\liiid\'  to  l)e1ie\'e  in  the  cleanliness  of  environment  as  a  pre- 
ventive of  disease  and  to  practice  it.  It  wanted  immigrants  inspected  and 
vaccinated. 

Iliiw  to  hring  these  things  to  pass  was  the  question.  The  State  Board 
of  1  Iealth  h.-iil  no  funds  availahle  to  undertake  such  stupendous  tasks  with 
its  own  emjikives.  A  way  out  was  found  hy  the  diligent  and  resourceful 
Ranch. 

The  vellow  fever  crisis  ol  IS'iS,  as  it  was  regarded  at  the  time,  led  the 
Slate  I'loard  of  Health  to  test  its  power  granted  under  that  clause  in  the  law 
w  hich  read  : 

•• and   sliall  liave  authority  to  nialce   such  rules  and  regulations,   and   such 

sanitary  investigations  as  tliey  may  from  time  to  time  deem  necessary  for  tlie 
preservation  or  improvement  of  public  healtli " 

The  Pioard  made  some  rigid  ([uarantine  and  sanitary  regulations  con- 
cerning the  rail  and  steamlmat  iraflic  coming  into  the  State  from  the  lower 
Alississippi  and  it  put  the  transpniialinn  mteresls  to  work  at  complying  with 
these  rtgulations.  A  few  inspectois,  lempor  iry  at  first,  were  employed  by 
the  Txiard  lo  >ee  that  the  rules  were  carried  nul.  Thus  il  was  discovered 
lli.it  in  making  a  rule,  which  had  the  weight  of  law,  the  State  Hoard  of 
lle.ilth  could  increase  enormously  the  health  machinery  without  any  material 
increase  in  expenditure.  This  was  ihe  beginning  (if  "rules  and  regulations" 
and  we  shall  see  how  Dr.  Ranch,  with  the  su])])ort  of  the  Board,  turned  this 
earlv  e\]urience  to  good  account  in  carrying  out  his  sanitary  and  vaccina- 
tion plans. 

('nilf(  rl    nf   Actinll. 

W  hen  Dr.  I\auch  was  elected  secretary  in  the  spring  of  18T!)  the  ambi- 
tions of  the  .State  ISoard  of  Health  to  "sanitate"  and  vaccinate  the  State 
began  lo  resolve  into  plans  and  ]iraclical  application.  Cherishing  his  national 
])oinl  of  viiw  he  took  aihantage  of  e\ery  opportunity  and  created  oppor- 
innilit'-  li>  m.ake  Cdni.acl  with  (Uilside  .igencics.  Thus  in  April,  18T9,  almost 
iinnudi.aleK  .after  be  became  seeielary  of  ihe  State  Board  of  Health,  he 
went  1(1  .\bniphis  .and  gdl  himself  elected  secretary  of  the  Sanitary  Council 
I  if  the  Mississi]ipi  \alley,  an  iiUerstale  \dluntary  organization  created  at 
lli.il  lime.  Its  function  wa^  tn  keeji  member  health  officers  informed  of  all 
epidemic  oiubreaks.  t-speckill}-  of  yellow    fever,  and  to  draw  u])  uniform  sani- 


PUBLIC    IIICALTIl    ADMINISTUATION  143 

tary  rules  and  regulations  which  all  nieniliers  agreed  to  adopt  and  enforce  in 
their  several  states.  This  strengthened  the  i)u1)lic  health,  machinery  in  Illi- 
n(.iis  bv  adding  the  weight  of  group  opinion  to  propcjsed  plans  and  by  pro- 
viding timely  information  serviceable  in  promoting  pr(]mpt  action  on  local 
plans. 

How  an  effective  working  contact  was  made  with  the  National  ISoard 
of  Health,  a  federal  agency  created  by  Congress  in  ISIS  with  a  $.")()0,()00 
appropriation,  in  May  and  with  transportation  interests  in  July  of  1879  is 
best  described  by  Dr.  Rauch  himself  who  gives  this  acc(]unt  in  the  second 
annual  report  of  the  State  Board  of  Health: 

"While  the  Illinois  State  Board,  through  its  executive  officer,  was  thus 
exerting  its  influence,  beyond  its  own  boundaries,  to  secure  such  a  general  sani- 
tary reform  throughout  the  entire  valley  as  would  prove  the  best  safeguard  against 
the  Introduction  of  epidemic  disease  from  without,  the  National  Board  of  Health, 
in  anticipation  of  the  act  of  Congress  increasing  its  powers  and  resources,  was 
seeking  trustworthy  information  upon  which  to  base  such  actions  as  the  law  might 
empower  it  to  take  in  the  discharge  of  its  duties.* 

"In  response  to  a  telegraphed  invitation,  received  May  2S.  the  Secretary  re- 
paired to  Washington,  for  conference  with  the  National  Board,  and  on  June  1  pro- 
ceeded to  New  Orleans,  under  confidential  instructions  from  the  executive  com- 
mittee of  that  body.  These  instructions  involved,  among  other  matters,  a  report 
upon  the  general  sanitary  condition  of  New  Orleans,  and  an  inspection  of  the 
Mississippi  quarantine  station,  seventy-five  miles  below  the  city.  Returning  to 
Washington,  on  June  S.  two  da.vs  were  spent  in  consultation  with  the  executive 
committee:  and  during  this  conference  the  situation  in  the  Valley,  from  St.  Louis 
to  New  Orleans,  was  thoroughly  discussed,  the  various  available  sanitary  agencies 
were  duly  canvassed,  and  divers  plans  were  suggested  for  most  efficiently  extend- 
ing the  cooperation  and  aid  of  the  National  Government,  through  this  organization, 
to  'State  and  municipal  boards  of  health,  in  the  execution  and  enforcement  of 
the  rules  and  regulations  of  such  boards  to  prevent  the  introduction  of  contagious 
and  infectious  diseases  into  the  United  States  from  foreign  countries,  and  into  one 
State  from  another.' 

"A  code  of  rules  and  regulations  was  also  prepared,  and  recommended  for 
adoption,  for  ports  designated  as  quarantine  stations:  for  securing  the  best  sani- 
tary condition  of  steamboats  and  other  vessels:  also,  the  best  sanitary  condition 
of  railroads,  including  station  houses,  road-beds,  and  cars  of  all  descriptions:  and 
the  precautions  to  be  enforced  in  a  place  free  from  inspection,  having  communica- 
tion with  a  place  dangerously  infected  with  yellow  fever;  and  when  .yellow  fever 
is  reported  or  suspected  to  exist  in  any  town  or  place  in  the  United  States.  As 
the  general  adoption  of  this  code  would  tend  to  secure  uniformity  of  practice 
throughout  the  Valley,  and  thus  promote  efficiency  in  preventive  measures,  the 
agency  of  the  Sanitary  Council,  through  its  secretary,  was  invoked  to  attain  this 
desirable  result.  The  Sections  relating  to  island  quarantine  were  subsequently 
referred  to  a  committee  composed  of  Drs.  H.  A.  Johnson,  of  Chicago,  R.  W, 
Mitchell,  of  Memphis,  and  S,  M,  Bemiss,  of  New  Orleans,  members  National  Board 
of  Health.  Representatives  of  other  sanitary  organizations,  among  them  the  Sec- 
retary of  the  Illinois  State  Board  of  Health,  were  invited  to  confer  with  this  com- 
mittee.    The  report  is  as  follows: 

"By  invitation  of  the  committee  appointed  to  confer  with  the  representatives 
of  the  railroad  and  steamboat  interests  of  the  Mississippi  Valley,  representatives 
of  these  interests  met  in  the  city  of  Memphis,  July  2,  lS7fl,  and  organized  by  elect- 
ing Dr.  R.  W.  Mitchell,  Chairman,  and  Dr.  John  H.  Rauch,  of  Chicago,  Secretary. 
The  following  lines  and  companies  were  represented:  Mr.  James  Montgomery, 
Louisville  and  Nashville  Railroad;    Mr.  J.  D.   Randall,   Memphis  and   St.   Francis 

*  The  act  referred  to  was  not  approved  until  .June  2.  but  the  iiiemher.s  of  the 
Board,  realizing  the  gravity  of  the  .sitiiati  m,  louli  sueli  iireliniinary  steps  as  were 
possible   at   this   time. 


141  ITI'.I.IL     lll;AI.rll     ADM  IMSTKATIDX 

River  Packot  Company;  Mr.  W.  E.  Smith,  Memphis  anil  Little  Rock  Railroad 
Company;  Mr.  M.  S.  Jay.  Memphis  and  Little  Rock  Railroad  Company;  Mr.  M. 
Burke,  Mississippi  and  Tennessee  Railroad  Company;  Dr.  J.  I!.  Lindsley,  Chatta- 
nooga, Nashville  and  St.  Louis  Railroad  Company:  Mr.  T.  S.  Davant,  Memphis 
and  Charleston  Railroad  Company:  Capt.  Ad.  Storm,  St.  Louis  Anchor  Line  Packet 
Company:  Mr.  R.  A.  Speed,  Memphis  and  Arkansas  River  Packet  Company; 
Captain  Lee,  Memphis  and  Friar's  Point  Packet  Company:  Capt.  R.  W.  Lightbarne, 
Memphis  and  Cincinnati  Packet  Company.  The  'rules  and  regulations  for  secur- 
ing the  best  sanitary  condition  of  steamboats  and  other  vessels,  also  the  best  sani- 
tary condition  of  railroads,  including  station-houses,  road-beds  and  cars  of  all 
descriptions,'*  were  read  separately,  discussed,  and  unanimously  approved.  Assur- 
ance was  given  of  the  cordial  cooperation  of  the  railroad  and  steamboat  interests 
in  all  measures  adopted  by  the  National  Board  of  Health  in  their  efforts  to  pre- 
vent the  spread  of  contagious  and  infectious  diseases.  All  that  was  asked  was 
that  all  rules  and  regulations  adopted  by  the  National  Board  of  Health  be  made 
uniform  at  all  places  and  ports.  The  representatives  also  approved  the  recom- 
mendations made  by  the  Mississippi  Valley  Sanitary  Council  as  a  special  measure 
of  protection  to  the  Mississippi  Valley,  that  stations  of  insiirction  be  established 
at  Vicksburg.  Memphis  and  Cairo." 

Thus  by  iniilsuinnier  of  ISID  ;l  fmir  cuniered  tirgaiiizatidii  fur  lighting 
disease  in  Illinoi.s  had  been  jjerfected.  It  incktded  the  State  Board  of  Heahh 
and  such  voluntary  assistance  as  it  was  able  to  stimulate  within  the  State, 
the  Sanitary  Council  of  the  Mississippi  \'alley  which  furnished  morbidity 
intelligence,  the  Xatinnal  Board  of  Health  which  formtilated  interstate  sani- 
tary requirenit-nts  ;ui(l  the  conference  of  Sanitarians  and  Transportation 
Inlerests  which  ]iut  into  cM'ect,  through  the  resources  of  the  common  car- 
riers, the  sanitary  measures  agreed  upon. 

By  titilizing  every  ounce  of  ])o\ver  that  could  l)e  S(|ueezed   from  these 

sources  by  means  of  persuasion  and  threats.  Dr.  Ranch  was  able  to  e.xtcnd 

the  influence  of  his  sanitary  ideas  throughout  the  length  .'ind  1)readth  of  the 

Mississippi  Valley.     \\  ithin  a  few  months  from  the  time  when  the  Sanitary 

Council  was  organized  he  was  able  to  report : 

"At  the  beginning  of  this  section,  'Yellow  Fever  in  1S79'  there  is  given  a 
comparative  statement  of  freight  movements  over  the  Illinois  Central  railroad  in 
187S  and  1879,  showing  an  increase  of  plus  37  per  cent  in  the  latter  as  compared 
with  the  former  years.  In  this  statement  will  be  foinid  an  illustration  of  the 
effect  upon  commerce  by  the  different  systems  in  vogue  in  the  management  of 
yellow  fever  in  the  respective  years.  In  1S7S  there  was  a  quarantine  practically 
excluding  ever.vthitig  that  came  from  the  south,  while  in  1S79  it  was  one  of  sani- 
tary inspection,  including  only  dangerous  articles.  This  result  could  not  have 
been  brought  about  without  the  cooperation  of  the  National  Board  of  Health, 
since  neither  the  Illinois  State  Board  nor  the  Cairo  Local  Board,  without  this 
cooperation,  could  have  permitted  the  immense  amount  of  material  to  be  brought 
into  the  State  from  the  south  during  the  months  of  July,  August,  September  and 
October.  It  required  the  constant  presence  of  the  Secretary  at  Cairo  (especially 
in  July  I,  and  repeated  assurances  to  the  local  authorities  that  every  precaution 
was  being  e.xercised  by  the  National  Board  and  the  Louisiana  State  Board  of 
Health  at  New  Orleans,  and  other  organizations  along  the  entire  route,  to  prevent 
the  introduction  and  spread  of  the  fever  northward,  to  allay  their  fears,  as  this 
year  a  majoi-ity  of  the  citizens  of  Cairo  were  favorable  to  a  quarantine  of  exclu- 
sion. Such  was  the  feeling  of  apprehension  that  fully  one-third  of  the  population 
of  Cairo,  from  July  15  to  September  1,  was  ready  to  leave  the  moment  the  first 
case  appeared,  no  matter  whether  it  was  of  foreign  or  local  origin." 

uloptprl   by   the   S;init,iry   Cciincil   at   Atlanta,   witli 


PUBLIC   HEALTH    ADM  I  .\  ISTKATIOX  143 

How  he  played  one  force  against  another  is  suggested  in  a  telegram 
sent  by  Dr.  Ranch  on  October  3.  ISIK,  to  the  secretary  of  the  National 
Hoard  of  Health.     It  read: 

"I  am  almost  constantly  advised  by  telegraph,  no  matter  where  I  am.  of 
the  condition  ot  affairs  throughout  the  whole  Valley  and  1  am.  therefore,  in  posi- 
tion to  judge  intelligently  of  the  situation." 

The  intelligence  set  forth  in  this  coninnmicatiun  was  obtained  ihroiigh 
the  operation  of  the  Sanitary  Council  of  the  Mississippi  Valley  and  the  pur- 
pose of  the  message  was  to  bring  the  National  Board  of  Health  to  support 
Dr.  Ranch's  plan  for  combating  yellow  fe\er  at  the  moment.  Everywhere 
in  the  records  of  his  work  it  is  patent  that  Dr.  Ranch  kept  well  informed 
of  epidemic  outbreaks  all  over  the  world,  so  far  as  that  was  possible.  Time 
and  again  he  went  before  the  national  congress,  the  State  legislature  and 
other  organizations  with  his  jilans  and  invariably  he  would  recite  stories 
of  epidemics  abroad,  naming  foreign  cities  with  the  familiarity  of  a  native 
and  quoting  figures  and  relating  circumstances  like  a  local  observer.  Small- 
jiox,  cholera  and  yellow  fever — these  were  the  diseases  he  was  fighting. 
When  sanitarv  interest  and  activity  in  the  State  tlireatened  to  grow  sluggish. 
Dr.  Ranch  would  begin  to  search  the  skies  for  ei)idemic  clouds.  Invariably 
he  found  them,  usually  an  Asiatic  cholera  thundercloud  that  flashed  and 
rumbled  with  deadly  threats. 

Still  catering  to  his  national  viewiioint  Dr.  Ranch  resorted  again  to  his 
"concert  of  action"  idea  in  1881  when  smallpox  outbreaks  in  the  State  be- 
gan to  take  on  serious  aspects.  Tlds  time  he  took  it  uijon  himself  to  call  a 
conference  which  again  is  best  described  in  his  own  words,  taken  from  the 
fourth  annii.'d  report  of  the  State  Board  of  Health,  which  reads  as  follows; 

"Early  in  the  following  June.  (ISSl),  the  Secretary — convinced  by  past 
experience  of  the  futility  of  independent  preventive  measures,  confined  to  States 
and  municipalities,  while  the  disease  was  increasing  in  the  chief  European  ports, 
and  thousands  of  unprotected  immigrants  were  pouring  into  the  interior,  and 
after  consultation  with  leading  sanitarians — issued  a  call  for  a  conference  of 
health  authorities.  National,  State,  and  local,  with  a  view  to  co-operative  action 
by  all  interested,  and  especially  with  reference  to  the  arrest  of  further  introduc- 
tion of  the  contagion  from  abroad.  This  Conference,  which  was  held  in  Chicago. 
June  29-30,  was  attended  by  representatives  of  the  National  Board  of  Health,  and 
of  eighteen  other  health  organizations  in  fourteen  different  States.  After  full 
deliberation  the  Conference  recommended  that  Congress  incorporate  into  the 
laws  regulating  immigration,  a  provision  requiring  protection  from  smallpox  by 
successful  vaccination  ot  all  immigrants:  that  the  National  Board  of  Health  con- 
sider the  propriety  of  requiring  the  inspection  of  immigrants -at  the  port  of  de- 
parture, the  vaccination  of  the  unprotected,  and  the  detention  of  the  unprotected 
exposed  until  it  was  certain  that  they  were  not  carrying  the  germs  of  the  disease 
on  shipboard  for  the  infection  ot  the  vessel  and  the  transportation  of  the  disease 
into  the  United  States:  that  measures  be  taken  tor  the  quarantine  detention  of 
steamships  bringing  immigrants  not  provided  with  proper  evidence  of  vaccinal 
protection;  that  local  health  authorities  inspect  all  immigrants  arriving  in  their 
respective  jurisdictions,  and  enforce  proper  protective  and  preventive  measures 
when  necessary;  and  that,  'to  meet  present  emergencies,'  the  National  Board  of 
Health  secure  the  inspection  of  all  immigrants,  and  the  vaccination  of  the  unpro- 
tected, before  landing  at  any  port  of  the  United  States." 


PRESIDENTS 

llUaols  Stala  £)oard.   of   Health, 


isrr  -  •  W79 

mJtm 

M'^>§/f?.s^-^L.D. 

Hocace  ^acdnct,9Tl.D. 

ISZ9-/SSI 


9Uvi'toa  BaUiiiau.lL.D. 


PUBLIC   HEALTH    ADXr  INISTRATION  147 

As  an  outcome  of  the  Chicago  Snialljiox  Conference  the  National  Board 
of  Health  inaugurated  an  Inmiigrant  Inspection  Service  in  June  of  18iS2. 
It  iivovided  physicians,  stationed  at  railway  terminals  throughout  the  coun- 
try, will'  examined  immigrants  and  vaccinated  all  of  those  susceptible  to 
sniallpnx  who  were  enroute  to  territory  over  which  the  inspector  had  charge. 
1  )r.  Ranch  was  appointed  chief  inspector  for  the  western  district.  The  in- 
spection service  continued  oidv  seven  moinhs  liut  during  that  brief  period 
ll.j.O.'iT  iinniigrant>  liound  fdr  Illinois  werr  examined  and  ".M.illS  vaccinated 
against  smallpox.  \\'hile  this  service  lasted  the  tive  inspectors  located  at 
Chicago  and  the  two  located  at  St.  I.cmis  and  Indianapolis  respectively,  added 
great  strength  to  the  health  machinery  in  Illinois  and  doubtless  led  to  the 
coast  cjuarantine  service  which  subsecjuently  relieved  states  from  work  and 
apprehension  covering  the  health  of  immigrants  to  this  country. 

('(1)11  prcli cits') vc  State  S)i )')'(' t/. 

While  working  with  interstate  ami  national  agencies  for  the  sake  of  pre- 
\enting  the  introduction  of  disease  from  the  outside,  the  State  Board  of 
Health,  through  its  secretary,  was  not  idle  in  promoting  sanitary  activities 
widiin  its  own  state  boundary  lines.  In  December  of  18T8  the  Board 
adopted  a  form  for  use  in  making  sanitary  surveys.  Plans  for  the  use  of 
these  forms  and  what  was  expected  to  be  gained  therefrom  are  expressed 
in  the  first  annual  report  of  the  Board  as  follows : 

"This  schedule  of  ciuesticns  embraces  everything  appertaining  to  the  sanitary 
interests  of  any  city  or  town,  and  it  can  be  carried  out  without  a  great  deal  ot 
expense,  as  the  local  medical  men  or  societies  will  no  doubt  cheerfully  answ'er  all 
the  queries  contained  therein.  The  information  asked  for  is  necessary  to  a  cor- 
rect understanding  of  what  is  needful  to  be  done  to  improve  the  sanitary  condi- 
tion of  any  city  or  town  in  this  state.  While  this  information  is  being  obtained,  it 
at  the  same  time  stimuJntes  the  siudij  of  sanita)-y  scirnrc  all  over  the  State.  It  is 
therefore  very  important  that  this  survey  should  be  made." 

The  first  survey  forms  were  sent  out  to  8  communities  in  southern 
Illinois  during  the  spring  of  ISV-K  After  yellow  fever  brc.ike  out  in  the 
lower  Mississippi  Valley  during  that  summer  the  forms  were  sent  t<i  -!' 
other  inunici])alilies.  The  percentage  of  response  was  rather  disappointing 
but  the  idea  of  making  sanitary  surveys  through  local  people  continued  to 
grow  until  it  culminated  during  iss.'i  in  over  Mimi.ikhi  inspections  in  o'.l."j 
cities,  towns  and  villages  in  '.HI  of  the  ll)-J  countie-.  This  stU|iendous  task 
was  made  jxissible  through  services  voluntarily  rendered  by  hundreds  of 
local  phvsieians.  school  teachers  and  others  who  had  been  interested  in  the 
matter  bv  fear  of  a  cholera  epidemic.  Dr.  Ranch  himself  had  inspired  this 
fear  when  he  recited  to  the  Board  at  its  i|uarterly  meeting  in  July  bssl, 
the  storv  of  cholera  in  Europe  during  two  preceding  years,  suggested  that 


14S  pviu.rc  iii;ai.tii  administration 

the  disease  ^eciiR-d  to  l)c  snicmldcriiij^  ready  for  a  disastrous  flare-up  that 
might  possibly  leap  the  Atlanlie  and  concluded  that: 

" my  own  experieiue  aiui  observation  lead  to  this  conclusion  tliat  it  is  not 

judicious  to  place  entire  reliance  on  quarantine  measures,  no  matter  how  admin- 
istered, should  the  disease  become  epidemic  in  countries  or  points  with  which  this 
country  has  close  commercial  relations.  As  Asiatic  cholera,  although  it  may 
Invade  places  of  good  sanitary  conditions,  finds  its  most  congenial  habitat  where 
filth  in  any  form  abounds,  the  best  attainable  sanitary  condition;  clean  streets  and 
premises;  the  prompt  and  proper  disposal  of  organic  refuse,  night-soil  and  all 
forms  of  sewage;  well  ventilated  habitations,  with  dry  clean  basements;  a  pure 
and  sufficient  water  supply;  and  good  individual  hygiene,  including  personal 
cleanliness,  proper  diet  and  regular  habits  of  life — these  are  the  best  safeguards 
against  Asiatic  cholera,  as  they  are  against  most  diseases." 

This  was  the  idea  underlying  the  sanitary  survey  which  brought  to 
thi'  State  I'xiard  nf  llealth  detailed  records  of  the  environmental  conditions 
of  iixvv  .KMi.dUd  premi>t-s  and  much  information  concerning  local  epidemics 
.■uid  famiU  lu-:dih  histories.  The  achievement  of  this  stupendous  task  is 
signilicanl  here  llecau^c  it  shows  hiiw  the  Board  was  al)lc  to  bring  into  action 
hundreds  of  l(ic;d  peii|ile  lh;U  ])Ut  the  State's  ln'alth  machinery  int(i  im- 
mediate li.uch  with  praclicalU"  e\er\   household  in   lllin(iis. 

Vaccinal  Kill  (if  School  ('hihlnii  llc([iiiri'(l. 

Another  illustration  of  the  same  means  for  expanding  the  health  ma- 
chinery of  the  State  was  based  upon  a  resolution  passed  by  the  State  Board 
of  Health  on  Xovember  'i'i.  is.si.  which  reads; 

'•RRSOU'llD.  That  by  the  authority  rested  in  this  Board,  it  is  hereby 
ordered.  Ihiif  on  and  after  January  I.  iSSj.  no  f^upil  shall  be  admitted  to  any 
pnblie  sehotd  in  this  State  7vithouf  pi-esentin;/  satisfaetorv  e^'idenee  of  f^roper 
and  siieeessfnl  I'aeeination." 

Acting  upon  this  authority  Dr.  Kauch.  as  secretary  of  the  Board,  made 
ready  such  fonus  as  were  necessary  for  i)roviding  children  with  vaccina- 
tion certiricates  and  for  collecting  the  desired  reports  for  office  records 
ami  study.  Then  he  plunged  into  the  task  of  communicating  the  order  to 
all  school  officials  and  teachers  in  the  State.  So  energetically  was  the  iob 
prosecuted  that  by  January  2-i,  1882,  he  was  able  to  say: 

"1  doubt  if  the  people  of  any  other  state  of  equal  age  are  as  well  protected 
against  smallpox  as  those  of  Illinois  at  the  present  time." 

In  a  comiilete  report  that  was  jniblished  later  ap])ears  the  assertion 
that ; 

"Nearly  500  Individuals,  embracing  attending  physicians,  and  municipal, 
town  and  county  officers,  have  contributed,  each  in  his  proper  capacity,  to  the 
Information  furnished  as  to  the  introduction  of  the  contagion,  its  mode  and  ex- 
tent of  propagation,  the  measures  resorted  to  for  its  suppression  and  their  result, 
the  cost,  actual  and  constructive,  and  other  noteworthy  features.  In  like  manner, 
the  vaccinal  history  of  304.586  public-school  children — based  upon  physicians' 
certificates  of  vaccination — has  been  furnished  by  over  8.000  teachers;  49.3 
physicians  have  reported  the  results  in  187.22:5  vaccinations  at  all  ages;  and  the 
vaccinal  status  of  1<S.70S  inmates  of  public  institutions,  private  and  parochial 
schools,  colleges,  academies,  etc..  has  also  been  given — making  an  aggregate  of 
5111.517  individual  vaccinations  and  revaccinations." 


PUBLIC   HEALTH    ADMINISTRATION 


149 


This  shows  an  amazing  increasL-  in  ihe  i)uhlic  health  machinery  which 
accomphshed  its  purj)osc  within  sixty  days  alter  it  was  started  resuhing 
in  an  increase  in  vaccination  of  fr(im  I.")  Ui  !il  per  cent  of  all  school  children. 
Power  to  so  enlarge  the  health  niachiner\'  was,  of  course,  hased  upon  an 
interpretation  of  the  law  giving  the  Slate  Hoard  of  Health  "General  super- 
vision of  the  interests  of  the  health  and  life  of  citizens  of  the  State.'" 


Conpcrat i(iu   iritli   Loral  Aiilhnrlilrf;. 

Another  means  employed  by  the  State  Board  of  Health  to  augment  the 
available  machinery  for  getting  health  work  done  in  the  State  was  the  pro- 
motion of  the  organization  of  local  boards  of  health,  in  the  smaller  munici- 
]ial  antl  rural  communities.  Nearly  all  the  large  cities  had  health  organiza- 
tions at  the  time.  Ijut  it  re(|uire(l  stimulation  to  keep  them  going.  Under 
pressure  of  local  epidemic  outbreaks  and  iiropaganda  featuring  possible 
dangers  from  cholera,  smallpox  and  yellow  fever,  boards  of  health  came 
into  existence  here  and  there  from  time  to  time. 

Available  records  show  that  local  organizations  were  formed  in  the 
larger  communities  in  Illinois  as  follows : 


Cairo    1S18 

Belleville     1S19 

Alton    1S21 

Urbana     1833 

Chicago    1835 

Ottawa     1837 

Bloomin.gton     1839 

Danville     1839 

Decatur    1839 

Quincv    1839  (As  a  town 

inlS25) 

Peltin    1839 

Peoria    1839 

Springfield    1840 

Jacksonville     1840 

Galesburg    1841 

Marion    1841 

Rock  Island   1841 

Blue  Island  1843 

Joliet    184.5 

Canton    1849 

Collin.sville    1S50  (town) 

1872  (city) 


Lasalle    1852 

Wauke.gan    1852 

Aurora   1853 

Elgin    1854 

Preeport 1855 

Kankakee    1855 

Moline    1855 

Freeport   1857 

Lincoln    1857 

Centralia  1859 

Mattoon 1859 

Champaign   1861 

Rockford   1862 

E.  St.  Louis 1865 

Murphysboro   1867 

Kewanee   1872 

Streator    1874 

Maywood    1881 

Chicago  Heights 1892 

Harvey    1895 

Granite  City 1896 

Herrin    1898 


By  l.ssti  enough  local  interest  in  sanitary  matters  had  been  stirred 
up  t(j  bring  39  representatives  of  as  manv  local  municipalities  to  a  sanitary 
conference  called  by  Dr.  Ranch  to  meet  in  S])ringfield  on  May  21st.  Of 
those  in  attendance  1-3  were  registered  as  health  officers,  13  as  members  of 
local  boards  or  committees  of  health.  ■;  as  mayors  and  the  other  tour  as  city 
engineer,  town  trustee,  city  attorney  and  city  treasurer  respectively.     \\  hat 


150  ITIil.Jt'    lll-,.\l.in     ADM  IMSTKATION 

traiispin-'d  at   \hc  amivrvucv  may  In-  siirniisccl    I'luni  llic  rcpurt  of  a  com- 
mittee oil  roolutions  which  rca<ls  : 

"1.  That  to  insure  the  proper  sanitary  condition,  it  shall  be  the  duty  of  the 
health  officers  to  require  a  prompt  special  inspection  o£  all  buildings  and  premises 
within  the  corporate  limits  of  town,  village  or  city,  to  report  same  to  proper 
authorities,  and  to  cause  all  nuisances  to  be  abated  as  tar  as  practicable. 

"2.  All  town,  village,  or  city  authorities  should  be  informed  toucliing  the 
influence  of  sucli  sanitary  supervision  of  domiciles  and  places  of  labor,  on  sick- 
ness and  death  rates,  and  tliey  are  hereby  requested  to  make  a  prompt  and  proper 
appropriation  of  means  for  tire  performance  of  this  work. 

"3.  The  registration  of  births  and  deaths  liaving  been  too  greatly  neglected 
in  the  past,  it  is  urged  that  ordinances  and  rules  be  made  by  the  proper  authori- 
ties on  this  sub,iect,  both  for  the  procuring  of  necessary  information,  purposes  of 
identification,  and  also  to  inform  the  sanitary  authorities  of  the  condition  of  the 
health  of  the  neigliborhood. 

"4.  The  importance  of  vaccination  and  re-vaccination  should  be  impressed 
upon  all  school  authorities,  and  the  laws  of  the  State  thereon  should  be  promptly 
and  vigorously  enforced." 

How  primitive  the  ideas  ]irevailini,'  then  ;il)oul  sanitation  were,  is 
shown  in  a  ([uestion  put  hcl'orc  the  conference  l)y  Hr,  T.  M .  -Mcllvaine, 
heahh  officer  of  Peoria,  who  wanted  to  know  if  j)ii;-peiis  should  V)e  called 
a  nuisance  and  in  what  towns  they  had  hecn  aholished. 

This  conference  never  resulted  in  a  closely  knit  organization  but  it  has 
contir.ue.l  to  this  d,-i\-  under  \arious  names;  meeting  sometimes  regularly 
but  more  frequently  with  a  lapse  of  some  years  between.  Its  purpose 
was  nianifestlv  to  bring  into  etTective  cooperation  the  State  and  local 
health  ;igcncies  h)-  mutual  discussion  and  understanding  of  common  prob- 
lems, 

Il/th  s  mill  liriinhil iiiiis. 

The  very  hrst  use  of  the  power  vested  in  the  Stale  Board  of  Health 
''to  make  such  rules  and  regtilations  ....  as  thcv  may  from  time  to  time 
deem  necessary  .  .  .  ."  was  jieremptorily  exercised  by  the  president  of 
the  Board,  Dr.  John  W.  Ranch,  at  Cairo  (.m  July  2!),  18T8  when  yellow- 
fever  threatened  to  invade  the  Slate.  His  action  placed  an  absolute  embargo 
on  freight  and  |)assengers  from  the  epidemic  region  into  Illinois.  In  this 
action  the  I'oard  later  concurred. 

l''roni  lh;u  lime  forward  new  rules  were  nKidc  and  old  ones  modified 
as  occasions  arose  until  ISs.'i  found  the  I'.oard  with  a  set  of  regulations 
which  rcqniicd  all  children  in  the  public  schooK  lo  be  vaccinated  against 
smalljiox :  (|uarantine,  isolation,  etc.  of  persons  sick  with  smallpox,  di|)h- 
thcria,  scarlet  fever,  t\-j)hoi(l  fever.  Asiatic  cholera  and  yellow  fever:  the 
rejiorting  of  cases  of  contagious  disease  directly  to  the  secretary  of  the 
State  Hoard  of  Health:  prohibition  of  tr;uisp(ining  dead  bodies  of  per- 
sons who  ha  1  died  from  smallpox,  cholera  and  yellow  fever  and  any  other 
dead   bodies   during  the   summer   nioiilhs   except   under   siiecilicd   conditions. 


PUBLIC    HEALTH   ADMINISTRATION  151 

These  rules  and  regulations,  the  development  of  which  i^  recited  in  another 
chapter,  have  always  formed  the  back  bone  uf  the  State's  health  machinery. 
Schemes  for  making  them  work  have  always  been  the  task  that  confronted 
executive  officers  whose  duty  it  was  to  provide  the  niaximnm  in  sanitation 
and  hygiene  with  the  rescurces  at  their  command. 

Law?,  relating  to  he:ilih  crept  into  the  statute  books  from  the  very 
outset  of  organized  government  in  Illinois.  The  e  were  changed,  rejiealed, 
modified  and  added  to  from  time  to  time  as  the  divi>ion  of  labor  brought 
whole  groups  of  persons  to  depend  more  and  more  ujjon  other  individuals 
and  groups  for  supplies,  the  utilization  of  which  had  a  direct  influence  over 
health  and  as  sanitary  and  hygienic  knowledge  increased.  By  1885  there 
were  laws  authorizing  cities  and  villages  to  establish  boards  of  health  and 
making  the  supervisor,  assessor  and  town  clerk  of  every  town  a  board  of 
health  to  function  outside  of  incorporated  cities  ;ind  villages.  There  were 
also  numerous  laws  relating  to  food,  milk,  nuisances,  etc.  To  promote 
desirable  sanilar\-  practice  and  uniformilv  of  procedure  throughout  the 
State  the  State  Board  of  Health  drew  up  what  wa>  termetl  a  Model  Sanitary 
Ordinance  and  recommended  its  adoption.  In  this  ordinance  an  attempt  was 
made  to  codify  all  existing  laws  relating  directly  to  lu-ilth  as  well  as  the 
rules  of  the  State  Board  of  Health  that  had  to  do  with  ipiarantine,  report- 
ing of  contagious  disease,  and  sanitary  conditions.  It  also  embraced  articles 
on   vital  statistics,  burial   permits,   etc. 

Jiti'iifinii   fn    U'dfcr  Siipiilii's. 

Water  supplies  attracted  the  attention  of  Dr.  Ranch  throughout  the 
whole  period  of  his  association  with  State  health  service.  Never  was  he  too 
busy  to  think  and  talk  about  the  importance  of  safeguarding  drinking  water 
from  pollution.  l-'re(|uentlv  he  found  time  to  make  extensive  held  studies 
himself.  (Jften  he  arranged  for  others  to  do  it.  Scarcely  a  rejiort  came 
from  his  office  that  di<l  not  present  data  collected  relative  to  some  new 
investigation  of  water  supplies.  The  very  first  annual  statement  of  the 
Board  contained  an  expenditure  item  of  >i^l!).2o  for  costs  involved  in  '.he 
collection  and  analysis  of  samples  of  water  taken  from  the  Chicago  River. 
During  the  \'ears  that  followed  samjdes  were  fre(pientlv  taken  from  many 
other  streams  as  well  as  from  jntblic  and  private  supplies.  Studies  and 
observations.  frei|uently  carried  cnit  by  Dr.  Ranch  himself,  were  often  con- 
ducted for  months  at  a  tinie.  Even  after  leaving  the  State  Board  of  TIealtli 
as  its  secretary.  Dr.  Ranch  was  employed  by  the  Board  to  study  the  water 
supply  question.  Tie  had  nuich  to  do  with  proxiding  a  jiotable  water  in 
Chicago  just  i)rior  to  tin-  (ireal   World's    hair  in   that   city. 


lo2  ri'iii.ic  iii:ai.tii  admixistkation 

Ediiratioiial  ^Ictiril ics. 

I'^ducaliiin  >>i  llu-  juililic  thruugh  the  inililiLaiidii  aii.l  (listri1)Ulii)n  of 
special  iiampliU-lh  and  through  the  newspapers  was  recognized  from  the 
outset  as  a  \alualilc  means  for  extending  the  pubhc  health  machinery  of 
the  State.  The  early  annual  reports  of  the  State  Board  of  Health  are 
rejjlete  with  lengthy  dissertations,  reports  and  quotations  on  sanitation. 
Education  was  one  of  the  chief  purposes  of  the  great  sanitary  survey 
which  really  began  in  Is'IS.  In  1881  a  circular  entitled  "Concerning  the 
Pre\;entinn  of  ."-Smallpox"  was  published  and  distributed  widely  throughout 
the  State.  I'.v  lss."i  circulars  on  smallpox,  diphtheri.i,  scarlet  fever  and 
t\])hoid  fever  had  lieen  published  ami  hundreds  of  thousand'-  of  co])ies 
distributed.  Correspondence  on  these  and  other  sanitary  m.'Uters  was 
\oluminous. 

The  sanitary  ideals  toward  which  the  first  State  health  officials  strove, 
and  ]iarticularlv  Dr.  Ixauch  whose  ideas  dominated  the  activitv  of  the 
Hoard  e\'en  before  he  became  its  executive  secretary.  wei"e  two-fold.  On 
the  one  hand,  the  desire  was  to  so  educate  the  people  that  they  could  and  would 
vo'untarily,  through  personal  action  and  local  health  officers,  put  into  prac- 
tice the  sanitary  and  hygienic  measures  calculated  to  preserve  and  promote 
health  and  thereby  make  imneccssar\-  a  large  corps  of  State  health  workers. 
( )n  the  other  hand  the  desiie  w;is  to  bring  into  existmce  interstate,  national 
and  international  m.achinerv  which  woidd  function  so  as  to  ])revent  the 
introduction  of  diseases  from  without  and  to  keej)  the  State  health  officials 
informed  of  world  health  conditions. 

To  the  end  of  realizing  these  ideals  the  contacts  heretofore  referred 
to  were  made  and  the  activities  mentioned  were  undertaken  ])rior  to 
the  close  of  ISS.").  This  general  scheme  continued  wi'di  but  few-  and  not 
\-ery  important  exce]itions,  to  govern  the  plans,  policies,  organization  and 
])erform,-inces  of  the  State  ])ublic  heallh  machinery  in  Illinois  until  the  close 
of  the  nineteenth  century. 

Dr.  Ranch  continued  as  executive  .secretary  of  the  Stale  Boanl  of  Health 
until  June  :il).  ls!il,  when  he  resigned  and  was  succeeded  ])\  Dr.  Frank 
W.  Reilly  of  Chicago  on  ."^ejitember  21,  If^iH,  Dr.  \\\  R.  AlacKenzie  of 
Chester,  a  member  of  the  Board,  lilling  in  ihe  iiUerim. 

Arc()i)ij)lislniiiiif.s. 

Throughoru  the  1  1  ye.ars  of  his  connection  willi  the  State  Board  of 
Health,  m<isl  of  which  lime  w;is  s])ent  as  its  secretary.  Dr.  Ranch  was 
easily  the  central  ligure  of  public  health  machinery  and  thought  in  the  State. 
He  exercised  no  insigniticani  iulluence  over  the  s.anitary  and  hygienic  policies 
and  practices  in  the  nation  ruirl  atlractc-d  notice  of   foreign  countries.     His 


PUBLIC    HEALTH    ADM  IN  ISTRATIOX  153 

idras  alxiut  yellow  fever  made  an  especial  appeal  in  Europe  and  were  made 
the  suhject  of  a  lengthy  and  favorable  editorial  in  the  December  lo,  IS.ss, 
edition  of  the  London  Lancet.  The  extent  and  character  of  Dr.  Ranch's 
activities  as  a  sanitarian  are  succinctly  ex])ressed  in  a  resolution,  adopted 
by  the  State  Board  of  Health  when  his  resis^nation  was  accepted,  which 
reads : 

WiiEBE.\s,  Dr.  John  H.  Ranch,  after  fourteen  years  continuous  service,  has 
severed  his  connection  with  the  Illinois  State  Board  of  Health,  having  on  the  30th 
day  of  June  last,  tendered  his  resignation  as  its  Secretary,  the  following  resolu- 
tions are  hereby  adopted,  as  in  some  degree  expressing  the  sentiment  of  the 
individual  members  of  the  Board  toward  their  friend  and  colleague: 

Resolved.  That  Dr.  Ranch's  services  in  the  cause  of  sanitary  science  and  of 
the  best  interests  of  the  medical  profession  have  given  the  State  of  Illinois  a  grati- 
fying pre-eminence  not  only  in  this  country,  but  wherever  the  sanitarian  and  the 
physician  are  known  and  recognized  as  useful  members  of  society. 

Resolved.  That  Dr.  Ranch's  eminent  attainments  as  a  practical  sanitarian, 
illustrated  in  his  management  and  control  of  epidemics,  his  reformation  of  the 
theory  and  practice  of  quarantine,  his  establishment  of  a  system  of  immigrant 
inspection  on  sea  and  land,  his  conservation  of  the  purity  of  food  supplies  and 
products  and  his  work  in  the  domain  of  preventive  medicine,  place  him  in  the 
front  rank  of  those  who  devote  their  lives  to  the  material  welfare  of  their  fellow 
men. 

Resolved.  That  to  Dr.  Ranch's  untiring  energy,  to  his  vigilance  and  to  his 
intimate  personal  knowledge  of  the  profession,  both  in  his  own  State  and  in  the 
country  at  large,  are  chiefly  due  the  establishment  of  a  body  of  efficient  legis- 
lation, regulating  the  practice  of  medicine — legislation  whose  precepts  and  adjudi- 
cated cases  have  been  copied,  adopted  and  endorsed  by  older  commonwealths. 

Resolved.  That  his  wise  aggressiveness,  his  forethought,  sagacity  and  per- 
sistence, in  the  face  of  manifold  obstacles,  have  nowhere  been  more  strikingly 
displayed  nor  more  usefully  employed  than  in  his  successful  efforts  to  elevate  the 
standard  of  medical  education. 

Resolved.  That  Dr.  Rauch's  personal  sacrifices  in  the  discharge  of  his  duties 
as  member.  Secretary  and  President  of  the  Illinois  State  Board  of  Health — sac- 
rifices known  to  every  member  of  the  Board — are  deserving  of  grateful  recogni- 
tion and  substantial  reward  by  the  people  of  the  State  for  whom  he  has  so  long 
and  so  faithfully  labored. 

Resolved.  That  the  individual  members  of  the  Board,  whose  names  are  hereto 
appended,  are  unable  adequately  to  express  the  regret  caused  by  Dr.  Rauch's 
resignation  and  the  esteem  in  which  he  is  held  by  them.  They  earnestly  enter- 
tain the  hope  that  he  may  lon.g  be  spared  to  counsel  and  advise  with  them  and 
their  successors  in  matters  touching  the  lives  and  health  of  the  people  of  the 
state. 

W.  A.  H.\SKi.;ix,  A.  M.,  M.  D.,  Harv. 
Nkwtojs'  B.\tem.\n,  LL.  D. 
An.son  L.  Clark,  M.  D. 

R.   LUDL.VM,    M.   D. 

WuAAAM  R.  M.\cKi':xziF..  M.  D. 
D.\.\iel  H.  "Williams,  1\I.  D. 
B.  M.  GuiFFiTiis,  M.  D. 

The  things  of  noteworthy  niagnitudi,-  which  had  come  to  pass  during 
I)]-.  Ranch's  incumbency  and  which  brdught  into  action  the  available  health 
ni;icliiner\-  of  the  State  were  brielL'  a,^   fullows: 

1.  The  State  had  been  clean>i'd  of  uni|ualilicd  practitioners  of  nu-di- 
cine.     I'hysicians  who  ■were  allowed  to  piactice  held  bi>n,-i   tide  credennals. 


154  rUHI.K'    HEALTH    ADMIXISTKATION 

and  medical  education  had  been  raised  to  a  considerably  higher  levi-l.  This 
work  was  achieved  largely  by  the  State  Board  of  Health  itself  whdse  mem- 
bers served  without  pay  and  met  frequently  in  all  parts  of  the  State. 

2.  Practically  every  household  in  the  State  had  been  inspected  from  a 
sanitary  point  of  view.  This  was  accomplished  through  tlie  voluiilary  serv- 
ices of  local  people. 

.■>.  Nearly  every  school  child  in  the  State  had  been  vaccinated  against 
smallpox.  The  law  making  it  the  dulv  of  local  officials  to  carry  out  the 
orders  of  the  State  Board  of  Health  and  that  empowering  the  Board  to  make 
rules  and  regulations  were  invoked  to  bring  success  in  this  case. 

I.  \'ital  statistics  such  as  reports  of  births  and  deaths  were  collected, 
comiiiled  and  published  in  great  detail  for  the  years  of  1880  to  1886  in- 
clusive. While  estimated  to  be  about  48  \k-v  cent  incnniiilete  for  births 
and  31  per  cent  for  deaths,  the  machinery  for  collecting  them  was  set  in 
motion  and  even  in  so  incomplete  a  condition  Ihev  furnish  valuable  data 
for  comparison  with  present  day  conditions.  This  task  was  accomplished 
li\'  putting  county  clerks  to  work,  at  this  task  as  the  law  required,  and 
b\-  utilizing  the  limited  clerical  resources  availaljle  to  the  Board. 

"i.  Rules  and  regulations  concerning  (|iiarantine  and  sanitation  had 
been  adopted,  their  enforcement  wa^  i)riini(ile(l  through  ;i  law  creating  local 
boards  of  health   throughout   the   Stale. 

(i.  Exhaustive  studies  of  stream  ijolluiinu  in  the  State  and  of  water 
supplies  and  sewer  facilities,  e^pecialh'  in  L  hicago  had  been  luade.  'Ibis 
had  been  accomplished  largely  ])y  the  jjcrsonal  etTori  of  Dr.  Ranch  himself 
and  the  analytical  laboratory  service  which  was  ]iaid  for  out  of  the  general 
office  exjiense  fund. 

7.  The  phvsical  exaiuinalion  of  immigiants  for  the  specril  purpose 
of  ])reventing  smallpox,  cholera  and  yellow  fever  was  in  general  ]iractice 
along  the  .Vtlantic  seaboard  and  sjioradicalh'  inl.ind.  This  had  coiue  about, 
to  ^ome  exteiU  at  least,  because  of  contact  with  outside  agencies. 

S.  'J'he  influence  of  the  foremost  s.anilarian^  all  oxer  the  country  had 
made  itself  felt  in  Illinois.  This  had  resulted  from  the  prominent  |)art 
taken  bv  Hr.  Ranch  in  organizing  and  parlicii)ating  in  .-i  dozen  national 
sanitary  movements. 

r.ven  after  his  resignation  as  secretary.  Dr.  Ranch  contiiuied  to  ex- 
ercise a  direct  influence  over  the  sanitary  thought  of  the  State  and  the 
policies  of  its  health  machinery.  Indeed  he  was  time  and  again  called  back 
to  duty  b\-  the  ISoard  of  Health  in  the  cajiacitx-  of  Sanitarv  Counsel.  ( )nly 
death,  which  clo-ed  the  career  of  thi^,  uni([ue  ligure  in  the  public  health 
history  of  the  countr\-  in  March  of  ISKI,  could  eliminate  him  as  a  luaster 
figure  in  the  sanitar\-  thought  and  activities  of  his  Slate. 


PRESIDENTS 

llliaois  State  Jboatd.  of   Hcaltk 


W.A.HaskdX.m.D. 

/ssr  '  IS 93 


JoKaA.Vlnar\t,9U.D. 

/S93  "  1894 


V^.E.QuuuL,  m.D. 

l&9-^  -  /S9<S 


B.m.GdffltK.m.a 


1S9S-  IS9r 


15G  rUIiLIC    HEALTH    ADMiMSTRATION 

Dr.  luillji  Sicyrlarij. 

Dr.  keilly  liad  Iktii  closely  associated  willi  the  State  Board  of  Health 
since  JiSlS  whrii  he  was  employed  l)y  it  to  work  as  a  medical  inspector  in 
the  yellow  fever  zone.  I'or  many  _\ears  lu-  was  assistant  secretary  nnder 
Dr.  Ranch.  Dnriny  his  I'imr  years  in  otttce  he  carried  forward  the  policies 
and  activities  that  had  l)een  [)reviouslv  eslahlished.  There  was  one  notahle 
exception  in  the  coniinnity  of  iiolicy.  In  1S92  an  attempt  was  made 
to  divorce  the  work  relating-  to  re,2;nlating  the  practice  of  medicine  and 
that  inviilved  in  sanitation  and  hygiene.  The  Hoard  anthorized  Dr.  Reilly 
to  work  with  the  legislatnre  tcjward  that  end.  The  idea  was  to  create  a 
board  of  medical  examiners  and  leave  the  Slate  Board  of  Health  to  fnnciion 
only  in  the  field  of  sanitation  and  hygiene. 

\'erv  rajiid  progress  had  been  made  in  the  science  of  bacteriology  dur- 
ing the  eighties  and  apparently  Dr.  Reilly  was  more  inclined  to  put  faith 
in  the  discoveries  made  in  this  held  than  was  Dr.  Ranch.  It  is  easy  to  nn- 
derstand  how  a  health  officer  with  limited  resources  who  believed  in  the 
possibilities  for  service  disclosed  by  bacteriological  discoveries  would  grow 
restive  under  conditions  that  required  most  of  his  time  and  eflfort  to  license 
doctors.  An  active  imaginatinn  even  in  that  early  day  (if  liacteriology  could 
foresee  opportunities  for  expending  nnlioinided  resnurces  in  prosecuting 
sanitary  jirogranis. 

Dr.  Reilly  tended  mcire  tnward  the  idea  of  building  up  a  .^tate  health 
organization  than  did  Dr.  Ranch.  Trying  to  get  rid  of  the  Medical  Prac- 
tice Act  indicated  this  attitude.  He  also  managed  to  employ  out  of  the  con- 
tingency funds  a  corps  of  immigrant  inspectors  which  he  stationed  at  C  hi- 
cago.  Dr.  Ranch  looked  to  the  federal  government  for  such  service  and 
probably  regarded  the  matter  as  a  principle.  The  immigrant  inspectors 
constituted  the  onlv  ini])ortant  change  in  the  health  machinery  of  the 
State  under  Dr.  Rt-illy  and  this  was  discdntinned  when  Dr.  J.  W.  Scott 
of  Chicagc:  was  elected  secretary  to  succeed  Dr.  Reilly  on  Jnlv  5,  lSl);j. 

Dr.  ,1.  II'.  ScoH  Srrrrtari/. 

Under  Dr.  Scott  the  visitation  of  a  general  smallpox  epidemic  revived 
the  cominilsory  vaccination  rule  that  applied  to  school  children  which  had 
been  allowed  to  fall  iiUo  disuse.  This  time  its  enfurcement  was  accompan- 
ied by  considerable  litigation.  Two  suits  are  udteworthy.  One  was  an 
action  against  a  school  board  in  Wayne  Louniy  which  was  dropped  upon 
advice  of  the  Slate's  attorney  who  felt  that  conviction  was  impossible.  The 
other,  a  luandamus  proceeding  against  a  school  hoard  in  Lawrence  County 
went  to  the  Supreme  Court  where  the  decision  handed  down  in  November 
1895  was  against  the  school  board.     This  is  important  because  it  declared 


PUr.LIC    HEALTH    ADMINISTRATION  1  "i  ^ 

that  the  rule  of  the  State  Board  nf  He'ihli  requiring  evidence  of  vaccina- 
tion before  admitting  children  to  tlu-  puhlic  ^chonls  could  be  enforced  only 
when  smallpox  threatened  or  \va^  ininiinenl  in  a  particular  community. 
Henceforth  the  public  health  machinery  which  this  rule  had  ])reviousIy 
set  in  motion  could  be  utilized  (nilv  when  smallpox  ajipeared  in  a  commun- 
ity. 

Under  Dr.  Scott  the  conference  (if  State  and  local  health  officers  in 
Illinois  was  revived  under  the  name  of  the  State  Board  of  Health  Auxiliary 
Association.  The  fact  that  10<S  representatives  attended  the  meeting  in  1S!)4 
shoW'Cd  that  local  health  organization  had  grown  considerably  since  the 
first  meeting  of  this  kind  was  held  in  ISSS — when  :50  representatives  had 
responded  to  the  invitation.  At  the  meeting  in  1S!)4  a  strong  sentiment 
in  favor  of  uniform  procedures  was  manifested  and  to  that  end  the  Model 
Ordinance  was  reviewed  and  modified  and  its  adoption  recommended.  So  far 
the  (piarantine  rules  and  regulations  of  the  State  Board  were  general,  leav- 
ing specific  matters  to  the  discretion  of  local  authorities. 

In  1895  the  means  for  enlarging  the  State's  public  health  machinery 
were  enhanced  when  the  legislature  a])i)ropriated  $3,000  for  the  establish- 
ment of  a  vaccine  farm  and  ^o.Odi)  foi-  a  water  laboratory,  both  to  be  lo- 
cated at  the  State  University.  More  detailed  discussion  of  these  projects 
appears  in  the  chapter  on  laljoratories. 

Ur.  Scott  continued  as  the  secretarv  nf  the  Slate  Board  of  Health 
until  May  "i  I,  ISDI  when  he  was  succeeded  by  Dr.  James  .\.  I'^gan  of  Chicago 
who  occupieil  that  position  until  his  death  in   March   1!)13. 

There  was  no  material  change  in  the  health  machinerv  of  the  State 
l)etween  ISlin  and  1!)00  except  the  beginning  of  the  laboratory  work.  The 
strength  of  the  State  Board  of  Health  was  shifted  from  one  problem  to  an- 
(jiher.  At  one  lime  a  staff  inspector  was  em]iloyed  lo  examine  immigrants 
as  they  came  into  the  State.  At  another  time  a  milk  inspector  would  be 
put  to  work.  Then  attention  W'ould  be  conceiilraled  nil  yellow  fever  with 
all  hands  Inisy  in  Cairo,  making  inspections  of  jiassengers  and  freight  from 
the  South.  Again  the  examination  of  public  water  supplies  and  streams 
Wduld  iiilerest  those  in  charge  and  ex])erls  would  be  emphjyed  to  can'}' 
out  studies  in  that  held.  Smallpox  flared  up  occasionally  and  stinmlaled 
field  activitv  that  involved  expenses.  Law  suits  developed  from  the  en- 
forcement of   rules   and   this   led   to   the  eniplo\inent   of   legal   talent. 

All  of  the  personal  service  emjiloyed  by  the  State  Board  of  Health 
was  temporary  in  nature,  however,  excejit  that  (}f  the  secretary,  an  assistant 
secretary  and  a  small  clerical  staff'.  The  total  apprt)]iriation  for  the  routine 
expenses  of  the  State  Board  of  Health  during  the  last  year  of  the  nineteenth 
century  was  only  $9,250.     Of  that  sum  $3,000  was   for  the  salary  of  the 


158  PUP.Lic  iii:ai,iii  ahm  i  xisiration 

sc'crctarw  The  i>ay  of  a  chii-f  clerk  rfiluced  the  tutal  by  .$l.,S()U  more. 
'I'wo  clerks  were  entitled  by  law  U<  gvl  -l^-.M  .".0  tiiyether.  'i'his  left  $2,350  for 
travel  and  other  expenses  of  the  Board  members  antl  secretary,  printing, 
general  office  expense,  other  ])ersc:nal  services  not  regularly  employed,  etc. 
There  was  a  five  thonsand  dollar  contingency  appropriation  \yhich  the  vari- 
ous secretaries  tried  to  utilize  froni  time  to  time.  Ilow  successful  they  were 
dr|.eu(k'd  upon  the  whim  of  the  particular  governor  in  oflice  at  the  time 
and  upon  the  ability  of  tlu'  seeietar\-  to  jiicture  imminent  danger  from  any 
of  a  group  of  diseases  listed  in  the  appropriation  law. 

Thus  on  July  12,  IIKK),  the  State's  official  ])ubHc  health  organization 
was  2-i  years  t)ld.  During  that  time  this  infant  governmental  function 
had  survived  apjiarently  by  reason  of  its  stubborn  refusal  to  die  and  a 
tenacious  gri])  on  life.  From  then  on  its  growth  was  considerably  acceler- 
ated. 

Ecu  II  inc. 

.\t  the  beginning  of  this  short  cjuarter  of  a  centurv  there  was  a 
State  Board  of  Ilealih  with  an  executive  secretary  and  a  small  clerical 
staff.  .\t  the  end  of  it  there  was  a  Board,  an  executive  secretary  and  a 
clerical  .^taff  a  trifle  larger.  .At  the  beginning  the  Board  members  met 
frequently — thirteen  times  the  first  }ear — but  they  received  no  remunera- 
tion except  travel  exi)enses.  .\t  the  end  of  this  period  the  Board  members 
received  a  ])er  diem  pay,  their  tra\-el  expense  and  met  less  frec|uently,  rarely 
more  often  than  quarterly.  Thus  it  is  clear  that  the  health  work  of  the 
State  devolved  more  and  more  upon  the  executive  officer  of  the  Board. 
An  annual  contingency  fund  made  possible  a  medical  and  sanitary  field 
service  under  epidemic  conditions  while  sporadic  work  of  this  kind  could 
be  accomplished  out  of  the  routine  funds. 

During  the  ''■''  years  the  Board  of  Health  had  indulged  the  authority 
vested  in  it  by  law  to  make  "rules  and  regulations"  and  a  number  of  these 
efforts  had  been  tested  in  the  courts.  Thus  the  limitations  of  the  health 
machinery  had  been  pretty  well  estal)lished,  the  courts  leaning  to  the  view- 
that  dangerous  disease  must  be  present  in  a  community  before  drastic 
quarantine  or  sanitary  rules  ma\'  become  operative. 

Nearly  everybody  in  the  .State  had  come  into  eon'.act  with  the  .State 
health  organization  thi-ougb  the  vaccination  and  sanitary  survey  projects 
so  that  the  idea  of  doing  i)ublic  health  work  had  l.aken  root.  Local  boards 
of  beihh  had  more  than  doul]k-<l  in  number  during  ihe  period.  At  the 
same  time  the  prexailing  ])opular  notion  fixed  the  work  of  health  officers 
to  ])urel\-  enxironmeiUal  cleanliness — collecting  dead  .animals,  causing  abate- 
nienl   of   nuisances,  garbage  renioyal,  etc. 


PUBLIC    IllCALTII    ADMIXISTKATIOX  l.li) 

Sporadic  efforts  to  collect  vital  statistics  had  been  made.  County  clerks 
knew  that  it  was  their  job  to  handle  certificates  of  birth  and  death.  Doctors 
knew  that  the  law  required  these  reports.  The  State  Board  of  Health 
knew  that  it  was  legally  required  to  receive  and  compile  and  preserve  the 
statistics.  This  system  never  operated  successfully  enough  to  bring  reason- 
ably complete  returns  and  no  time  was  found  by  the  State  agency  to  compile 
and  publish  these  records  except  for  the  years  of  1880  to  1886  inclusive 

Contact  with  outside  agencies  had  been  established  and  cultivated.  This 
added  the  advantage  of  national  and  world  intelligence  of  epidemic  con- 
ditions as  well  as  sanitarv  and  hygienic  developments  to  the  State's  machin- 
ery for  doing  health  work. 

This  closed  the  probationary  or  Ranch  period.  Health  work  had  be- 
come established  in  Illinois.  Machinery  for  doing  it  was  now  regarded 
as  an  essential  and  permanent  factor  in  the  State's  government.  From  now 
on  it  began  to  expand,  take  on  new  activities  and  developed  into  a  strong 
agency  relying  more  and  more  on  its  own  resources  to  keep  diseases  under 
control  and  to  preserve  and  promote  good  health. 

The  Egan"  Regime. 

The  predominating  characteristic  of  public  health  service  under  Dr. 
James  A.  Egan,  who  became  secretary  of  the  State  Board  of  Health  in  July 
1S9T.  was  expansion.  Regulating  the  practice  of  medicine  and  allied  i)rofes- 
sions  had  reached  a  fairly  satisfactory  stage  and  still  consumed  1.")  or  SO 
per  cent  of  the  time  and  energ)-  of  the  State  Board  of  Health.  Dr.  Egan 
wanted  to  get  rid  cjf  it.  He  saw  large  possibilities  for  growth  in  the 
field  of  sanitation  and  hygiene.  He  began  to  examine  the  resources  at  his 
command  and  to  plan  for  ibeir  enlargement. 

Dr.  Egan  championed  from  the  outset  of  his  incumbencv  tlie  idea  of 
separating  the  regulation  of  the  practice  of  medicine  from  the  sanitarv 
work  and  to  this  end  he  sought  to  create  separate  State  machinerv.  He  also 
wanted  a  larger  State  sanitary  staiT  and  better  local  health  machinery. 
In  a  paper  read  before  the  State  Medical  Society  at  Galeslnn-g  on  Mav  !S. 
1898.  Dr.  Egan  declared  that  the  jicople  were  indis|iosed  to  ])ass  laws 
or  spend  money  for  sanitarj-  improvement  and  the  ])revention  of  disease. 
This,  he  thought,  was  because  of  wide  differences  of  opinion  among  sani- 
tarians. In  the  same  paper  he  advocated  legislation,  providing  for  the 
establishment  of  local  boards  of  health  and  the  separation  of  the  State's 
functions  relating  to  "medical  practice"  from  those  concenied  with  sani- 
tation and  hygiene.  There  was  scarcely  a  meeting  of  the  State  Board  of 
Health  after  Dr.  Egan  became  secretary  but  the  matter  of  getting  relief 
from  the  duties  involved  under  the  I\Iedical  Practice  Act  was  discussed. 


]IW  VVlU.ir    IIKAI.TII    ADMIXISTUATIOX 

I iicrcdsi-d  A pjii'ijirKilidiis. 

'l"hi'  nu'ctiii^^  III"  i1k-  ( icneral  Asseiii1)lv  in  1S!)9  gave  Dr.  Egan  his  first 
opportuiiit)'  to  begin  liis  expansion  inMgram  ilirough  legislation.  What  he 
wanted  is  outlined  in  a  report  from  him  U>  the  Governor  in  Januai-y 
of  that  year  which  set  forth  seven  specific  requests.    They  were: 

"First:  The  creation  of  a  State  Board  of  Medical  Examiners  to  examine  and 
license  physician.s  and  midwives. 

Second:  The  creation  of  a  local  board  of  health  in  every  city,  village  and 
town,  and  in  every  connty  not  under  township  organization,  certain  duties  to  he 
imposed  upon  such  Boards. 

Third:  The  forbidding  of  the  interment  or  cremation  of  a  body  dead  from 
any  cause,  in  any  portion  of  the  State,  except  upon  a  legal  permit,  the  burial  or 
cremation  permit  to  be  issued  by  the  nearest  health  officer  who  shall  be  required 
to  report  monthly  to  the  State  Board  of  Health. 

Fourth:  Granting  to  the  State  Board  of  Health  supervision  over  the  sources 
of  public  water  supplies  and  of  sewage  disposal  throughout  the  State. 

Fifth:  Granting  to  the  State  Board  of  Health  an  appropriation  commensurate 
in  a  degree  with  the  sanitary  duties  the  Board  is  expected  to  perform. 

Si.rtti:  Requiring  that  owners  of  cattle  condemned  tor  tuberculosis,  should  be 
adequately  compensated  by  the  State  tor  the  loss  of  the  same  when  it  can  be  shown 
that  the  owners  were  ignorant  of  the  fact  that  the  cattle  were  diseased  when  the 
purchase  was  made.  Requiring  also  severe  penalty  against  owners  who  fail  to 
promptly  report  sick  animals  to  the  inspectors,  or  who  oppose  any  attempt  to  the 
inspection  of  their  herds. 

Seventh:  Amending  'An  Act  to  Create  and  Establish  a  State  Board  of  Health 
in  the  State  of  Illinois,  approved  May  25,  1877,  in  force  July  1,  1S77.'  As  under 
the  recommendations  outlined  above,  the  majority  of  the  sections  of  this  Act  will 
be  amended,  I  would  recommend  that  the  entire  act  be  amended.  Section  2.  (The 
Power  and  Authority  of  the  Board),  especially  needs  careful  revision.  In  the 
opinion  of  the  Attorney  General,  this  section  is  weak  and  may  often  be  found 
inoperative  for  a  time  at  least." 

Out  of  this  ambitious  program.  Dr.  Egan  succeeded  in  getting  an  in- 
crease of  $'250  per  vear  in  appropriations  and  that  went  to  the  salary  of 
two  cleiks.  He  had  asked  for  an  increase  of  >(;2."i.(i()o.  That  was  the  be- 
ginning but  Dr.  I-!gan  was  de>tine(l  to  learn  how  to  gel  the  ear  of  the  law- 
makers and  how  to  mani])ulate  their  purse  string  pulse. 

But  there  were  (Jther  resources.  There  was  tlie  contingency  fund 
of  $5,000  i)er  year.  It  could  be  spent  with  the  consent  of  the  Governor 
"in  case  of  an  outbreak,  or  threatened  outbreak  of  any  epidemic  or  lualignant 
diseases".  To  get  it  the  task  was  onlv  to  convince  the  Governor  that  a 
malignant  disease  had  appeared  or  threatened  to  appear  in  the  St.ate.  This 
Dr.  Egan  could  do.  Prior  to  his  time  the  contingency  fund  usually  went 
back  into  the  treasury  untouched.  Im-oiii  now  on  a  year  r.arely  passe. 1  when 
it  was  not  drawn  ujum.  It  was  usvd  to  ji.ay  ]ihysicians  and  quarantine 
officers  appointed  for  s])ecial  duty  in  connection  with  yellow  fever  alarius, 
smallpox  outbreaks,  ty])hoid  fever  and  other  disea^i-s  and  for  sanitary 
service  in  flooded  areas  along  the  Oliio,  Illinois  and  Mississi]i])i  river  bot- 
toms. 


PUBLIC    HEALTH   ADII IXISTRATIOX  Ibi 

Pdi/iiK-iif  for  Field  ^Yorl^  Still  Undecided. 

But  the  State's  machinery  for  getting  sanitary  work  clone  was  liap- 
hazanl  at  best.  jNIembers  of  the  Board  of  Health  as  well  as  the  executive 
and  clerical  staff  were  heavily  burdened  with  licensing  doctors,  midwives, 
pharmacists,  etc.  Then  there  were  vital  statistics  to  be  collected  and  com- 
piled. Epidemics  more  often  invaded  than  threatened  the  State.  Everyl>ody 
agreed  to  the  need  of  expert  medical  and  sanitary  services  wherever  infec- 
tious diseases  became  epidemic  but  nobody  agreed  upon  who  should  pay  for 
such  services.  A  law  required  counties  to  pay  for  medical  services  in  in- 
stances where  the  patients  were  unable  to  do  so  even  though  not  classed 
as  paupers.  Another  law  appropriated  money  to  the  Board  of  Health  for 
use  in  such  emergencies.  Who  finally  paid  seemed  to  be  a  decision  arrived 
at  largely  by  skill  in  "buck  passing".  In  December  of  1898,  for  instance, 
a  smallpox  panic  at  Griggsville  caused  the  secretary  of  the  State  Board  of 
Health  to  employ  Dr.  Isaac  D.  Rawlings  for  duty  in  that  area  and  Doctor 
Rawlings  reported  great  difficulty  in  collecting  his  compensation  and  that 
of  nurses  employed  in  the  emergency  from  the  county  commissioners.  At 
another  time  a  group  of  nurses  employed  a  lawyer  who  appeared  before  the 
State  Board  of  Health  in  October  189!)  and  jiresented  a  claim  for  pay  for 
services  rendered  to  smallpox  patients  in  St.  Clair  County.  In  this  case 
the  Board  paid  the  bill.  Again  the  minutes  of  the  Board  at  its  January,  1!HI0 
meeting  show  that  it  paid  claims  aggregating  $210  for  work  done  in  con- 
nection with  smallpox  quarantine  in  East  St.  Louis  but  refused  to  pay  a 
supplemental  claim  of  $159.50  for  expenses  incurred  in  the  same  procedure. 
This  indicates  that  the  public  health  machinery  of  the  State  was  still  so 
chaotic  that  nobody  had  a  clear  conception  of  whose  duty  it  was  to  per- 
form the  sanitary  work  necessary  to  suppress  disease  and  a  still  more  con- 
fused notion  about  who  should  pay    for  it  once  the  work  had  been  done. 

Miscellajt eons  A cfi vities. 

This  confusion  expressed  itself  in  other  ways.  The  State  Board  of 
Health  had  power  to  make  rules  and  regulations.  So  did  cities  and  villages. 
The  one  should  not  conflict  with  the  other  but  in  the  face  of  alarming 
outbreaks  when  State  help  was  not  forthcoming  the  local  people  took  mat- 
ters in  their  own  hand.  Thus  "pest  houses"  and  "shot  gun"  quarantine 
came  into  vogue,  especially  where  smallpox  appeared  and  that  disease  seemed 
to  pursue  health  officers  in  those  days  like  an  evil  spirit. 

An  insatiable  reader,  Dr.  Egan  knew  what  was  going  on  in  the  held 
of  sanitation  and  he  began  to  transform  his  information  into  plans  as  soon 
as  he  found  himself  in  a  position  to  be  heard. 


SECRETARIES 

lllnois  State  Board   a^   Health. 


Amos  Sawyer  acted  as  secretary  for  fourteen  months  piior  to  the 
appointment  of  Dr.  Drake. 


PUBLIC  iii:ai.ti[  aomixistkation  lfi3 

At  the  quarterly  meeting  ^)i  the  State  Board  of  Health  in  October, 
1S98,  Dr.  Egan  presented  a  report  concerning  a  recently  established  state 
tuberculosis  sanitarium  in  Massachusetts.  It  was  so  favorably  received  that 
the  Board  instructed  Dr.  Egan  to  take  n])  with  the  next  legislature  the  mat- 
ter of  constructing  such  an  institution  in  Illinois.  The  1S!)!I  (ieneral  .\s- 
semlily  declineil  to  provide  for  the  construction  of  a  sanitarium  but  it  did 
l)ass  a  jnint  resolution  directing  the  State  Board  of  Ilealth  to  inxestigate 
the  matter  and  report  back  to  the  Governor  for  that  body.  This  indicated 
an  awakening  interest  in  sanitary  matters.     The  leaven  was  at  work. 

In  June,  1899  Dr.  Egan  arranged  to  spend  $4,000  for  making  stream 
pollution  investigations.  His  ]ilan  was  to  establish  ■,'()  observation  stations 
along  the  Illinois  River,  hire  an  engineer  to  kri']i  tluni  functioning  and  pay 
for  laboratory  tests  on  the  volume  plan.  This  scheme  was  carried  out,  add- 
ing considerable  volume  to  the  State's  health  niacbiner)-.  This  piece  of  work, 
it  may  be  observed,  ultimately  had  an  imj)ortant  bi'aring  on  the  outcome  of 
litigation  between  Illinois  and  .Missouri  over  the  (piestinn  of  stream  pollu- 
tion and  very  probably  was  undertaken  with  that  end  in  view. 

Tuberculous  cattle  offered  a  lield  for  expansion  and  Dr.  Egan  consid- 
ered taking  upon  the  State  ISoard  of  Ilealth  the  tuberculin  testing  of  herds. 
He  asked  the  opinion  of  the  .\ltorney  (ieneral  in  IS!)'.),  whether  the  Board 
had  power  to  so  do  and  received  a  favorable  leplw  rmbablv  the  reasnii  he 
did  not  go  into  that  work  was  lack  of  funds  so  he  cnntented  himself  with 
agitating  legislation  on  the  suliject. 

The  work  of  tuberculin  testing  herds  started  in  .Ma\-.  1S!I9  by  the  State 
Board  of  Live  Stcick  Commissioni'rs  and  has  since  been  continued  under 
that  agency  which  later  lost  its  identity,  becoiuing  a  part  of  the  State  De- 
partment of  .\grieulture  created  under  the  Civil  Administrative  Code  in 
1917. 

The  operation  of  the  State's  health  machinery  was  simplified  some  and 

the  power  centering  in  the  secretary  of  the    Huard  considerably   iticreased 

on  January   17.    IS'.)!)   when  tin-   State   Board  nf    Ilealth   passed   a   resolution 

which  reads : 

'■Ri'nohwd,  That  the  Secretary  of  the  Board,  Dr.  James  A.  Egan,  is  liereny 
appointed  executive  officer  of  the  Board  and  is  empowered  to  act  for  and  in  the 
name  of  the  Board  when  the  same  is  not  in  session." 

A  similar  resolution  was  ])assed  the  next  year  but  was  made  unneces- 
sary later  by  an  amendment  to  the  law  in  11(01  ])ermanentl\-  jmixiding  the 
same  thing. 

This  largely  oln-iated  the  necessity  of  called  n)eeliiig>  and  .it  the  same 
time  gave  the  secretary  a  free  hand  to  exercise  his  faculties.  Health  machin- 
ery in  the  .^tate  is  drifting  toward  (  ne  man  control. 


IG-t  PUBLIC    HEALTH    A1)M*I  N  LSTKATION 

L'])  to  this  time,  about  ]!)00.  nearly  all  requests  and  complaints  reach- 
ing the  State  Board  of  Health  had  concerned  the  practice  of  medicine.  Such 
expressions  as : 

"Three  petitions,  signed  by  fifty  pliysiciaus,  asking  for  an  investigation 
of  tlie  unprofessional  conduct,  etc."  and 

"Charges  of  unprofessional  conduct  have  been  received  by  the  Board  against 
nearly  100,  etc." 

appi-ar  in  the  early  annual  reports  but  lew  references  are  made  to  petition-' 
begging  for  investigations  of  outbreaks  and  endemic  iirevalence  of  diseases 
and  of  insanitary  conditions. 

beginning  in  the  nineties  the  Board  is  called  upon  more  and  more  fre- 
quently tur  help  in  sanitary  matters.  By  1899  every  meeting  of  the  State 
I'nard  iif  lleallli  brings  questions  about  water  supplies,  milk,  stream  pollu- 
tion, nuisances,  infectious  diseases.  The  deplorable  sanitary  conditions  in 
penal  and  charitable  institutions  of  the  State  are  aired  in  the  press.  A  com- 
mittee of  the  Board  investigates  and  reports.  Floods  at  various  places  in  the 
Stale  at  jieriodic  intervals  bring  requests  for  sanitary  investigations  espe- 
ci;dly  of  water  supplies.  The  public  conscience  is  beginning  to  awaken. 
I'dsiibilities  of  preventive  medicine  are  j)laving  upon  the  popular  imagina- 
tion.     I'he  time  for  exiianding  is  opportune. 

Ltiihlhifi  lliiii.sr  Iiispcclioii. 

A  law  making  certain  sanitary  regulations  concerning  lodging  houses 
in  cities  of  11(0,000  or  more,  which  confined  it  to  Chicago,  was  passed  by 
the  legisl.itnre  in  1S99  and  placed  under  the  State  Board  of  Health  for  en- 
forcement. The  liill  carried  an  emergency  clause  so  that  it  became  operative 
upon  a])]ircival  on  April  '^1,  IcSliH.  No  funds  were  appropriated  for  carry- 
ing out  the  provi>iuns  which  enumerated  minimum  air  space,  maximum  ca- 
paiily,  elc,  for  sleeping  rooms.  The  enforcement  of  this  would  necessarily 
require  ihe  constant  ser\-ices  of  a  considerable  staff"  of  inspectors.  Work 
was  started  in  a  small  waw  hdwexer.  when  Homer  C.  Fancher  and  Al.  M. 
Jonas  Wert'  appointed  as  chief  inspecldr  and  a^sistanl,  respectively,  on  July 
I").  IS'.l!!.  their  ]ia\-  tu  lie  dr;i\\n  \vn\\\  ihr  conlingenc\-  fund.  It  was  stipu- 
lated ibal  iheir  services  sh(inl<l  teiniinaic  on  (_)ct(iber  l-'iih  of  the  same  year. 
.\ri  angenunts  were  made  at  thai   lime  to  continue  ihe  wurk. 

b'ancber  died  during  the  aulumn  of  ISIi'.l  and  b'-dward  J.  Smejkal  took 
bis  place  as  chief  bidging  JKiu^e  inspector.  Aljciut  ibis  time  Smejkal  also 
bec.inu' .atlorney  \i>v  llie  Stale  Board  of  llealth.  lie  was.  iberefore,  brought 
inlii  iiilim;ite  conlacl  wilh  the  njieratidn  nf  the  llu.iril.  .\s  chief  lodging 
hnn>e  inspi'ctoi-  be  experienced  the  ini;i\iiidab]e  dilVicultx'  of  getting  pay 
prom])tly  fur  lii-^  own  servici'>  .ind  \\ui^v  ni  hi;  slaff.  This  was  because 
no    funds   had   been    speciliealh    pvuxided    fur   that    pmjiose   and   each   claim 


PUBLIC    HEALTH    ADMINISTRATION 


165 


for  pay  had  to  be  passed  on  by  the  Board  and  sometimes  by  the  Governor 
when  contingent  money  was  used.  Delays  of  from  three  to  six  months  were 
common. 

By  C)clol)er  of  lUiiO  a  staff  of  10  inspectors  were  emi:iio_\ed  in  Icnlging 
house  work  and  this  increased  the  ]kiv  difficuhies.  Under  these  circum- 
stances Smejkal  managed  to  lend  material  aid  in  securing  for  lodging  house 


ORGAFilZATIOn    OF 

STATE    BOARD  OF  MEALTM 

!90l 

STATE  BOARD  OF  HEALTH 

7  Nembera 

Members  porticipolina  in 
the  enforcement  of  riedical 
Pracfice  Act  with  oid  of  extra 
V     help 

1 

Chief    clerk 
Z  clerks 

1    executive  Secretary 

todqinq    House 
Inspection  Service 

1  Chief   Inspector 
3  Reqular  Inspectors 
1-20  Temporary  Inspectors 

Fig.  fi.    Effective  streiiKtli  at  tlie  end  of  twenty-five  years  of  existence. 


inspection  an  appropriation  of  $J"^,.")00  per  year  from  the  tieneral  Assembly 
in  1901. 

The  next  year  Smejkal  was  elected  to  the  General  Assembly  and  .soon 
became  an  influencial  member  of  that  body.  This  established  an  important 
connection  between  the  State  Board  of  Health  and  the  appro]iriating  body 
which  doulitless  had  considerable  significance  over  subse(juent  events. 


KKl  ITr.I.ll-    III'.AI/Ill    ADM  INISIKATION 

Colli  III  uiiicdhli'  Disidsi'  (' II  rail  re  Measures. 

In  his  annual  rcpurt  lo  the  (lovcnior  for  the  year  of  I'.IOO  Dr.  h's^aii 
reconnuended  virlnallv  ihv  same  lei^ishitive  pri)L;rani  that  was  outlined  two 
years   hefore,  addinj;   the   item   of  a   state  luliercul(]si>   sanilariuni. 

This  time  the  outeome  was  more  favorable.  The  a]]i)i'oprialiiin  junijied 
ficim  -^H.'-^Ml  to  $•.'",'. "il  10  per  annum  for  routine  ex|iendilures  while  the  con- 
tingencN  tyrant  increased  fmm  ^ri.iilio  to  .$1().(I0|)  per  year.  These  funds  l)e- 
canie  availahle  on  lul\-  1.  I'.Kll,  shortly  after  the  adji  urnment  of  the  (ieneral 
Asseml)ly. 

Of  the  $■.'■.'. :>tMI  a  sum  of  $l-.',:)iiO  had  l)een  set  aside  in  the  law  for 
lodging  hoii.'r'e  inspection.  This  left  hut  ^lO.dOii  f(ir  genei'al  work.  ( )n  the 
other  hand  there  was  the  $10,000  conlin.gency.  This  justified  a  plan,  at  least. 
for  liuildiniL;  u]i  the  health  machinery. 

In  July   1!M)1,  Dr.  I{gan  reported  to  I'ae  Board  at  its  regular  (piarterly 

meeting  that  ; 

"Despite  the  faet  tliat  there  is  no  available  appropriation  availaljle  for 
laboratory  purposes,  the  necessity  for  a  bacteriolosic  laboratory  for  the  prompt 
diagnosis  of  tuberculosis,  diphtheria  and  typhoid  fever  has  become  so  ui-gent  that 
the  Secretary  has  diverted  sufficient  funds  from  the  appropriations  for  investiga- 
tion of  contagious  diseases,  to  equip  a  laboratory  which  is  now  in  operation.  Suit- 
able quarters  could  not  be  obtained  in  the  Capitol  Building  and  offices  were  con- 
sequently taken  in  the  Odd  Fellows  Building,  in  Springfield,  the  best  equipped 
building  in  the  city  and  convenient  to  the  offices  of  the  Springfield  physicians. 
A  limited  but  adequate  equipment  has  been  installed  and  the  Board  is  now  mak- 
ing diagnostic  examinations  of  specimens  for  the  physicians  of  the  state  witliout 
cost  to  them." 

This  is  e\idence  that  plans  were  maii-rializing.  .\lioul  this  time  a  plan 
for  s\stcniatic  ^ervice  in  connection  with  epidemic  outl)i-eaks  was  also 
evolved.  A  corps  of  physicians,  located  in  \arioUs  convenient  jila.ces  through- 
out the  .State,  was  selected.  Arrangements  were  made  to  call  ui)on  anyone 
of  them  at  anv  time  when  necessity  ref[uired.  Remuneration  was  on  a  per 
diem  hasis.  .Money  cotild  legally  he  drawn  fi'om  the  contingency  fund  to 
defray  such  expjn.cs.  The  annu.il  financial  statements  of  the  Board  indi- 
cate thru  this  was  done.  The  system  \yas  sonn  \\  h;it  like  the  reserve  scheme 
in  the  national  military  organization. 

No  workahle  system  for  securing  jirom])!  and  complete  rejiorts  of  com- 
nuinicahle  disease  incidence  had  been  evolved  hy  the  State  Board  of  Health 
in  UK)-.'.  During  .\ti,gnst  of  that  year  when  (  hicago  found  itself  in  the 
ihri  es  of  a  >e\ere  txphoid  fever  (Uithreak,  the  cil\'  health  comnussioner.  Dr. 
.Arthur  R.  RcAUoUls,  re(ittested  from  the  secretar\-  of  the  Stale  P>oard  of 
Jleallh,  Dr.  JCgan.  information  concerning  tlu'  down  stale  prevalence  of  the 
disease.  Dr.  ICgan  dispatched  telegrams  to  health  otTicers  in  :!."i  towns  to 
get  the  desired  information.  The  rules  of  the  I'.oard  still  rei|uired  nofih- 
cation  of  diseases  luu   the  ni;ichiner\-  w  ;is  loo   feeble  to  enforce  it. 


PUBLIC    HEALTH    ADMINISTRATIOX  167 

Progress  Made 

But  with  all  of  its  inadequacy  the  health  niacliinery  was  Ijeginning 
to  impress  itself  upon  puhlic  men  who  were  ni  a  ])usition  to  help  it  grow. 
The  plan  which  worked  best  seemed  to  lie  that  (if  starting  something  and 
then  initting  the  matter  uii  lu  the  legislature  for  support.  Thus  the  lodging 
house  in^])ection  work  began.  Now  a  diagnostic  laboratory  had  begun. 
A  chemist  and  a  sanitary  engineer  had  been  employed  sporadically  and 
their  investigations  in  stream  pollution  promised  to  be  valuable  in  pending 
litigation  between  Illmois  and  Missouri.  .\  enr[)s  of  physicians  known  as 
sanitary  inspectors  were  organized  ready  fur  duty  when  called  upon.  The 
machmery  was  there  and  it  was  too  valuable  to  be  without.  How  the  po- 
litical leaders  felt  about  the  situation  in  \SWi  is  expressed  in  a  speech  by 
Governor  Yates,  delivered  at  Anna  on  ( )ctober  Mth.  Amung  other  things 
he  said : 

"The  sanitary  work  done  by  the  Board  must  interest  every  citizen  ot  the 
state.  The  Board  now  has,  as  tor  two  years  past,  a  corps  of  competent  medical 
inspectors  distributed  throughout  the  state,  prepared  to  investigate  promptly  all 
epidemics  and  all  reports  of  any  undue  prevalence  of  disease.  During  the  pas't 
four  years  the  Board  has  had  to  contend  with  three  epidemics  of  smallpox. 
Although,  until  the  last  year,  handicapped  by  an  inadequate  appropriation — only 
$5,000  annually  having  been  appropriated  tor  this  purpose,  against  $25,000  annually 
in  the  neighboring  states  of  Indiana  and  Wisconsin — the  Board  has  accomplished 
results  of  the  greatest  benefit  and  importance.  Through  its  efforts,  acting  with 
the  local  authorities,  the  epidemic  of  smallpox  has  been  kept  well  under  control 
during  the  past  year,  notwithstanding  the  fact  that  the  disease  had  reached  an 
epidemic  form  in  adjoining  states.  Smallpox  is  now  widely  prevalent  through- 
out the  Union,  but  there  are  comparatively  few  cases  in  the  State  of  Illinois. 

"Particular  attention  must  be  called  to  the  sanitary  investigations  made  by 
this  board  during  the  past  three  years,  ot  the  waters  of  the  Illinois  River  and  its 
tributaries,  with  special  reference  to  the  effect  of  the  sewage  of  Chicago.  Most 
exhaustive  and  elaborate  tests  and  analyses  of  the  waters  have  been  made  and 
the  results,  up  to  the  summer  of  1901.  published  in  two  comprehensive  and  com- 
plete reports.  A  report  of  the  investigations  made  during  the  past  year  will  be 
published  within  a  month.  Those  disinterested  and  independent  reports  of  a 
thorough  chemic  and  bacteriologic  analysis  of  water,  the  condition  of  which  has 
excited  so  much  controversy,  have  received  unusual  attention  at  home  and  abroad 
owing  to  the  fact  that  they  contain  testimony  ot  an  unimpeachable  character, 
given  by  a  body  which  has  but  one  object  in  view,  namely,  the  truth.  This  testi- 
mony is  of  inestimable  value,  not  only  to  the  people  of  Chicago,  but  also  to  the 
people  of  the  entire  state.  It  demonstrates  that  the  Illinois  River,  into  which 
four-fifths  of  the  sewage  of  Chicago  is  now  turned,  purifies  Itself  through  natural 
causes;  that  the  influence  of  Chicago's  sewage  ceases  long  before  the  Mississippi 
is  reached  and  that,  notwithstanding  the  enormous  pollution  800  miles  above,  the 
Illinois  River  at  its  junction  with  the  Mississippi  is  in  better  sanitary  condition 
than  the  Mississippi  at  that  point. 

"This  is  the  most  important  work  ever  accomplished  by  the  State  Board  of 
Health.  Not  only  has  the  Board  demonstrated  to  scientists  the  self-purification 
of  running  streams  and  thus  vindicated  the  wisdom  of  the  people  of  Chicago  in 
undertaking  one  of  the  greatest  engineering  projects  of  the  century,  but  also, 
to  use  the  language  ot  a  leading  Chicago  daily  newspaper,  'has  furnished  the 
most  conclusive  testimony  in  favor  of  the  contention  of  Illinois  in  the  suit  brought 
by  the  State  of  Missouri  in  the  Supreme  Court  of  the  United  States,  that  has  ever 
been  presented.'  Through  the  expenditure  of  a  few  thousand  dollars  in  scientific 
research,   the   State   Board   of   Health   has   saved   the   tax-payers   of   Illinois   very 


KiS  l'i;i!l,lr    IN'.ALTII    ADM  IXISTkATlOX 

many  thousands  of  dollars  and  lias  prevented  years  of  litlKation.  Tlii"  r(>ports 
made  by  the  State  Board  of  Health  on  the  effect  of  the  drainage  canal,  the  only 
published  reports  on  the  subject  extant,  will  undoubtedly  be  accepted  by  the 
Supreme  Court  of  the  United  States  as  trustworthy  and  conclusive  testimony 
that  there  is  little  or  no  contamination  in  the  water  supply  of  St.  Louis  which 
can  be  attributed  to  the  sewage  which  passes  through  the  Chicago  Drainage 
Canal." 

This  show.s  that  the  liailrrs  were  hci^iniiiiiij  tu  apjirccirilc  sanitary  de- 
velopments hut  science  iiad  lra\ele(l  too  fast  for  the  puhhc  at  large.  Bac- 
teriology had  been  horn  during  the  preceding  fifty  years  but  it  had  grown 
tremendously  and  es[iev-ially  toward  the  close  of  the  nineteenth  century.  The 
causative,  organisms  of  tuberculosis,  typhoid  fever,  diphtheria,  malaria,  dy- 
sentery, tetanus  and  other  diseases  had  been  isolated  and  described  ])rior 
to  1900.  Diphtheria  antitoxin  had  been  made  available.  Typhoid  vaccine 
could  he  purchased.  The  means  by  which  yellow  fever,  malaria,  typhoid 
fever,  diphtheria  and  a  luimber  of  other  infectious  diseases  sj)iead  had  Ijeen 
clarified.  Laboratory  diagnosis  of  diphtheria,  typhoid  fever,  tul)erculosis 
and  other  diseases  had  been  perfected.  Great  things  in  the  control  and  pre- 
vention of  diseases  were  possible.  The  practical  application  of  knowdedge 
at  hand  was  the  only  necessar\'  rei|uirenient.  This  depended  upon  jiublic 
appreci.-.tion  and  su])])ort. 

The  pul)lic  still  clung  to  its  traditional  idea  about  disease,  however,  and 
indulged  its  consummate  fear  about  some,  such  as  smallpox,  but  calmly  tnjer- 
ated  others  as  a  necessary  evil.  Those  who  heard  about  the  new  scientific 
procedures  were  still  skeptical.  Otherwise  funds  for  interpreting  the  scien- 
tific discoveries  into  practical  terms  and  for  a])plying  ])reventive  measures 
would  have  flown  more  ([uicklv  and  more  freel\-  from  the  aijpropriating 
agencies. 

The  (ieneral  Asseiubly  in  ]'.)():]  raised  the  appropriation  for  State  health 
work  ■''I,:;  10  above  lliat  of  1!H11  but  the  items  specified  were  still  general 
exce])l  for  lodging  bouse  inspection  and  clerical  work.  It  is  probable  that 
the  health  officials  had  no  very  definite  ])lan  of  organization  and  the  mem- 
bers of  the  General  Assembly  had  still  less,  fn  the  year  of  I'.HK)  uvw  items 
find  their  wav  into  the  ajiprojiriations  law.  Assistant  secretary,  laboratory, 
registrar  of  vital  statistics,  bacteriologist  were  terms  that  appeared  then 
fill'  the  lirst  time.  The  total  vearly  sums  granted,  exclusive  of  contingency 
which  remains  at  $1(1,0(1(1  have  risen  from  Sp26,8f)0  to  $:i2,860.  The  plan 
of  giving  birth  to  an  idea,  mu"sing  it  a'ong  as  an  infant  function  and  then 
turning  it  over  to  tlu'  ( ieneral  .\sstm1)ly  who  had  to  accejit  the  respoiasibility 
of  feeding  it  or  allowing  it  to  ]>t'rish  is  working  well.  An  assistant  director 
had  been  employed  in  10(1 1.  During  the  same  \ear  the  registrar  of  vital 
statistics  had  been  jilaced  in  eh.irge  of  the  bacteriological  laboratory.  The 
expansion  program  is  picking  up  moiueiUuni. 


PUBLIC    HEALTH    ADMINISTRATION  169 

Aiititoxiii  Distributed  and  Pasteur  Treatiuents. 

Beside  the  enlargement  of  ai)])ropriation  tn  the  State  Bciard  of  Heakh 
for  sanitary  purposes  the  VMKi  ( ieneral  .Vssembly  passed  two  other  ini]wjrtant 
laws  which  enlarged  the  health  machinery  considerably.  One  made  it  the 
duty  <if  the  State  Board  of  Health  in  ai)puini  one  or  more  agents  in  every 
ciiunt\-  who  were  required  to  keep  on  hanil  at  all  limes  a  supply  of  diphtheria 
antiloxin,  certified  to  by  the  State  Board  of  Health.  This  law  further  pro- 
\-ided  that  the  price  charged  for  antitoxin  should  be  reasonable  and  that 
the  i)0(ir  could  have  it  at  the  exjjense  of  counties.  The  State  Board  of 
Health  ihus  found  itself  in  a  iiosilion  to  exercise  considerable  influence 
in  the  choice  of  agents  throughnut  the  State  and  over  manufacturers  nt 
biological  products. 

The  other  law  appropriated  $2. 000  fur  ihe  I'asteur  treatment  of  poor 
people  bitten  by  rabid  animals.  Supervision  over  the  expenditure  of  this 
sum,  which  was  lo  be  handled  through  hospitals,  was  given  to  the  State 
Board  of  Health.  This  was  another  public  recognition  of  a  feature  of  ])re- 
ventive  medicine. 

The  antiloxin  agents  were  dul)-  appointed  in  IIHK!  but  this  arrange- 
ment did  not  satisfy  the  health  authorities.  Before  a  meeting  in  Springfield 
on  October  18,  1906,  of  the  State  Board  of  Charities,  at  which  (iovernor 
Deiieen  was  piesent.  Dr.  deorgr  W.  Webster,  president  of  the  State  Board 
of  Health,  advocated  the  manufacture  .and  free  distribution  of  diphtheria 
antitoxin  bv  the  State.  Xew  ^'ork  and  Massachusetts  had  already  begun 
that  practice.  Difficulty  over  the  clause  in  the  I'.H).')  law  wdiich  required 
counties  to  pay  for  antitoxin  issued  to  poor  pemile  had  already  developed, 
the  idea  that  the  State  was  to  pay,  having  prevailed  generally.  Thus  in  his 
annual  report  to  the  Governor  for  the  year  of  1906  Dr.  Egan  strongly  recom- 
mended the  free  distribution  of  dijihtheria  antiloxin.  This  led  in  ll^'T  lo 
an  appro])rialion  of  -$15,(1(10  per  annum  for  ih;it  imrpose  and  ihereb\-  es- 
tiblislied  a  new  and  important  jiiece  of  pulilic  health  machinery.  The  law 
(lid  not  ])ro\ide  for  the  manufacture  of  antiloxin  but  for  its  purchase.  I  his 
prcvi'inn  has  cnnlinued  from  year  to  vear  .■md  ])revails  to  this  day. 

MiHitli!//  HuIIi  till  PilhlisliriJ. 

.\ni)llu'r  im]i(jrlant  function  lh.it  started  in  I'.MIi;  was  the  publication  of 
a  monthly  bulletin  by  the  State  Boanl  nf  1  le.illh.  The  advantage  of  such 
an  educational  medium  had  been  apiireci.aied  fur  nian\-  year^  and  attempts 
h;i<l  ]ir(viouslv  been  made  to  start  ii  but  ihev  had  pro\-en  lemporarv  until 
nciw.  l'"r(im  this  time  on  some  sort  of  m(inihl\'  publication  was  ])rinteii  .-md 
distributed  with  more  or  less  regularity,  it  was  distributed  chiefly  to  phy- 
sicians and  health  officers. 


1T0  rrr.i.ic  iikaltii  aiimimstkatiox 

I) lilies  of  Board  Extended. 

Like  Dr.  Rauch,  Dr.  Egan  realized  the  ini])()rtaiice  of  safe  water  sup- 
plies and  always  found  means  to  keep  this  subject  ])rominent  among  activi- 
ties undertaken.  If  he  was  unable  to  employ  the  technically  trained  per- 
sonnel from  the  reg^ilar  appropriation  he  managed  to  get  hold  of  contingency 
money  for  that  purpose.  While  the  funds  for  ordinary  expenses  lasted 
he  would  draw  upon  them,  calculating  that  the  contingency  pur.se  string  would 
be  loosened  for  any  necessary  expenses  involved  in  emergency  epidemics. 
Later  the  State  Water  Survey  of  the  University  of  Illinois  offered  an  op- 
portunity to  get  sanitary  engineering  work  done  and  in  1906,  an  agreement 
was  perfecteil.  whereby  the  Slate  P>nard  could  call  upon  the  Water  Survey 
Bureau  of  the  L'niversity,  to  make  investigations  of  water  supply  and 
sewerage  systems  as  reque^te<l.  Whatever  the  difficulties,  the  fact  remains 
that  Dr.  Egan  managed  to  keep  this  matter  of  safe  water  supplies  and 
sewage  disposal  before  the  public.  The  litigation  l)etween  Illinois  and  Mis- 
souri had  ended  favorablv  to  Illinois  in  that  year.  The  State  Board  of 
Ilc.ihh  hail  engineiMed  and  paid  for  the  stream  piilhition  investigations 
which  had  been  an  imimrlant  factor  in  the  court  decision  and  had  received 
ample  credit  for  that  work.  This  added  considerable  prestige  to  the  Board 
of  Health  as  a  sanitary  agency,  l-'roni  this  time  on  until  it  established  a 
peimanent  sanitary  engineering  service  of  its  own  the  Water  Survey  was 
largely  depended  ujjon  to  do  that  sort  of  work. 

Again  the  appropriation  for  the  State  Board  of  Health  went  up  at  the 
hand  of  the  General  Assembly  in  IDUT,  the  chief  item  of  increase  being 
•$15,000  per  year  for  the  free  distri1)ution  of  diphtheria  antitoxin.  But  this 
was  not  the  most  important  extension  of  public  health  machinerv  in  that 
year.  A  law  ameinling  the  original  .^tate  ISoard  of  Health  .\ct  was  passed. 
It  specified  that  the  State  Uoard  of  Health  had  supreme  authority  over 
quarantine  matters  in  the  State.  It  ma<U'  it  the  dut\-  of  the  State  Board 
of  I-Ieallh  to  investigate  the  cause  of  dangerourlv  contagious  or  infectious 
diseases.  It  ga\e  the  Board  power  to  make  such  rules  and  regulations  as 
the  Biard  deemed  advisable  and  rei|uired  local  health  and  other  officials 
to  enforce  the  rules.  bTirtbernioie.  it  gave  the  exi'cutive  officer  of  the  State 
B(jard  of  llealtii  ]iower  t(i  take  charge  of  the  situation  w  liere\-er  local  health 
officials  lefn-ed  or  neglected  to  take  proper  steps  in  coinbaling  an  epidemic 
and  to  colk'ci  from  the  local  coniniuiiit\-  wliatex'cr  expenses  were  involved  in 
li.nidling  the  situation.  Tbi-,  same  law  g:i\e  the  l>oard  of  Health  specific 
anlboriiy  to  e-tablisb  and  maintain  a  cluniical  :iuil  ])acteriological  lalioratory. 

'flii'-  l.iw'  clarilied  matters  cnn>ider;dil\  .ami  establis'ied  the  State 
Hoard  iif  llealtb  \ery  definitely  as  the  supreme  lieallli  organization  in 
tin-  State,      kroni   this  time  forth   no  rule,  rculatiun   or  acti\it\-  of  local 


PUBLIC    HEALTH    An^^  I  N  ISTRATION  171 

health  nfficials  relating'  to  sanitation  and  quarantine  couKl  legalh'  he  in 
eontliet  with  those  of  the  State  lioard  of  I  k-allh.  To  lieconie  a  powerful 
anil  adequate  at;ency  for  comhating-  diseases  in  the  State  the  Boar<l  now 
needed  nnl\-  the  necessary  funds  with  which  {o  build  up  an  or,a;anizatioii. 
'Jdie  total  annual  appropriation  in  l!Mi:  was  $:i!),SOO.  Of  this  $i:),OnO 
were  for  lodging  house  inspection  in  Chicago  and  another  $l."i,()(M)  for 
the  distribution  of  diphtheria  antitoxin.  This  left  but  •$•<!;), 800  for  other 
actixities  and  $10. noil  of  that  had  the  "contingency"  string  tied  to  it. 
\\  hen  analyzed  it  is  found,  then,  that  less  than  $10,000  a  year  were 
easily  a\ailahle  for  field  ser\  ice  of  .a  really  scientific  nature  and  one-half 
of  that  was  made  u]>  of  the  salaries  of  tlu'  secretar}-  and  assistant. 

This  same  condition  |ire\ailed  in  \'J\:)  when  Dr.  Egan  died  while 
still  the  executive  secretary  of  the  State  Hoard  of  Health.  The  biennial 
appropriation  to  the  l.ioard  in  that  year  anKunited  to  $5  t;).;M9."^").  Hut 
this  enormous  sum.  compared  with  the  $"28,(iOO  for  the  bienninm  when 
Dr.  Egan  came  into  office,  did  not  change  the  complexion  of  the  State's 
machinerx'  inr  doing  sanitary  and  hygienic  work  as  much  as  might  be 
expected.  Potential  resources  were  axailablc  but  tlie  organization  of 
these  resources  was  poor.  A  diagnostic  ]al)orali  ir\-,  the  lodging  house 
ins])ection  ser\ice  in  Chicago,  the  distribution  nf  antituxin  and  the  \ital 
statistics  service  were  the  only  units  in  the  State's  public  health  inachin- 
erv,  except  that  in\-ol\-ed  in  the  regulation  of  the  practice  of  medicine, 
which  functioned  systematically  as  a  routine  business  in  lilb!.  .V  cor])s 
(if  plnsicians  located  at  convenient  ])oints  in  the  State  who  accepted 
temporary  dut\-  when  called  u]ion  were  depended  upon  for  field  ser\ice 
in  connecti(in  with  epidemic  outbreaks.  There  was  no  machinerv  opera- 
ti\e  for  c(illecting  reports  of  communicable  diseases.  The  Water  Sur- 
\ey  at  the  l/niversity  of  Illin.ois  was  <lepended  u|)on  for  lield  and  labora- 
tory  wcuk  Concerning  water  and  sewer  systems. 

Ciiiijxrdl inn  With  Other  Aficiicws. 

W  bile  manifesting  primary  interest  in  the  expansion  ()f  the  State's 
orticial  ]inl)lic  health  ser\ice.  Dr.  Ivgan  did  nut  neglect  outside  agencies 
of  inli.'rstate  and  national  character  mir  did  he  o\erlook  the  im])ortance 
of  local  health  machinery  in  his  own  St.ite.  lie  preserved  fa\drable 
contai't  with  the  .\merican  I'ublic  1  U'.ilth  Association  and  with  the 
organi/.atiou  which  is  now  called  the  I'onference  of  .^tate  and  I'rii\incial 
Health  .\uthi  irities.  lie  also  maintaimd  cout.act  with  cither  \dluntar\- 
interstate  organization  which  had  cciuie  intu  beim;  but  for  the  miist  part 
died  liUt  after  some  specific  ])r(ibleni  h.id  been  MiKeil.  That  was  the 
experience  (if  the  Sanitary  C'liuncil  of  the  Mississippi  X'allc}',  long  time 
defunct,  and  of  the  Conference  of   Western    lioards  of   Health.     These 


1T2  PUIll.U'    IIICALTII    ADMI.NISTUATIOX 

ag'encit's  j,'a\c  way  to  better  organized  and  better  supported  national  move- 
ments. 

In  liH)'.  tbe  Congress  of  the  United  States  created  the  U.  S.  I'ublic 
lleailh  and  Marine  llospital  Service.  This  had  a  direct  influence  over 
the  State  health  machinery  in  two  ways.  It  provided  an  inspection 
service  of  immigrants  at  ports  of  entry  into  the  coinitry  and  it  was  made 
a  part  of  its  duties  to  call  at  least  annnall}-  a  conference  of  state  and  ter- 
ritorial health  officers  to  meet  with  the  Surgeon  (ieneral.  This  latter 
jiroxided  a  splendid  means  for  the  interchange  of  ideas,  the  dissemina- 
tion of  information  concerning  new  discoveries  and  procedures,  uni- 
formit}-  of  practice  throughout  the  country  and  harmonious  cooperation. 
State  health  officers  took  advantage  of  this  new  piece  of  national  health 
machinery  when  thc\  initiated  a  meetiu'^"  called  l)y  the  Surgeon  General 
in  Washington  on  January  I!),  I!i0-'l,  to  consider  jiroblems  brought  before 
the  c<iuntr3-  because  of  an  outbreak  of  plague  in  Mexico  and  San  Fran- 
cisco. Dr.  ]""gan  ])articipated  in  this  conference  and  subsequent  ones. 
He  maintained  close  contact  with  this  new  federal  agency,  frequently 
calling  iq>on  the  Surgeon  ( iencral  for  ad\ice  and  assistance,  especially 
in  regard  to  \ello\v   fe\'er  outbreaks. 

Lucal  Boards  in  liural  Disfricfs. 

Largel\'  tlirough  Dr.  F,gan's  efirorts  there  came  into  existence  a  law 
in  191)1,  which  was  amended  in  1i)0.'!,  that  created  local  boards  of  health 
in  the  rural  districts  throughout  the  State.  In  township  organization 
the  superx  isor,  assessor  and  tnwn  clerk  of  e\er\-  town  was  made  a  local 
lioard  (if  health  to  functiim  outside  incoriiorated  \illages  and  cities. 
The  County  connnissioners  in  other  counties  constituted  the  board  of 
health.  This  provided  a  definite  local  authority  through  which  tlie  State 
Board  of  Health  could  function.  It  remains  to  this  day  the  macliinery 
through  wdiicli  the  State  healtli  officials  work  in  rural  areas. 

Dr.  Egan  tried  hard  to  get  a  law  making  it  compulsorv  on  cities  and 
villages  to  appoint  boards  of  health  and  also  to  get  a  state  tuberculosis 
sanitarium  but  failed  in  both.  A  large  number  of  sanitary  and  hvgienic 
regulations  in  which  Dr.  Egan  was  interested  and  for  which  he  worked 
was  written  into  law.  These  related  to  stream  pollution,  free  distribu- 
tion of  biologies,  \ital  statistics,  pure  food,  dair_\  ].iroducts,  common 
drinking  cups,  etc.  There  was  a  law  passed  in  UJOS  which  enaliled  cities 
to  establish  public  tuberculosis  sanitaria. 

h'rsionc. 

Dr.  l\gan  found  the  State  Board  of  Health  jtretty  well  organized  to 
enforce  the  ^ledicil  Practice  Act  and  he  left  it  so.     This  work  increased 


PUBLIC    HEALTH    ADMINISTRATION  173 

enormously  during  his  time  but  so  did  the  resources.  Fees  collected 
for  licenses  could  be  used  by  the  Board  for  expenses  involved  in  re!:;'u- 
lating  medical  practice.  These  fees  amotnited  to  $10,000  or  more  per  year. 
The  work  was  performed  largely  by  the  Board  members  themselves  with 
the  necessary  clerical  and  legal  assistance.  When  Dr.  Egan  began,  an  attor- 
ney was  chosen  and  paid  for  in  accordance  with  the  amount  of  work  done. 
When  he  left  there  was  provision  in  the  appropriation  law  for  hiring  an 
attorney  and  a  law  clerk. 

W'hen  Dr.  Egan  first  took  office  there  was  no  trained  corps  of  sani- 
tarians steadily  employed  to  promote  preventive  measures  against  dis- 
ease. At  the  end  of  his  incumbency  the  same  condition  prevailed. 
There  was  this  difference — Dr.  Egan  had  a  little  larger  ajjpropriation  for 
that  sort  of  work  and  he  had  learned  how  to  get  hold  of  the  contingency 
fund  on  the  one  hand.  (_)n  the  other  hand  he  had  designated  a  certain 
number  of  physicians  throughout  the  State  and  upon  whom  he  could  call  at 
will  for  temporary  duty. 

When  Dr.  Egan  came  into  State  health  service  there  was  practicall}- 
no  work  being  done  on  vital  statistics.  .At  the  end  of  his  time  there  was 
a  state  registrar  of  \-ital  statistics  and  clerical  assistants.  The  law  had 
been  changed  several  times,  apparently  from  bad  to  worse,  and  was 
still  unsatisfactory.  But  a  considerable  volume  of  records  were  secured 
and  they  were  compiled  and  preserved  in  good  shape  for  each  }ear  after 
1902  until  191 ;;. 

At  tlie  beginning  of  Dr.  Egan's  term  the  practice  was  to  emiiloy 
sanitar}'  engineers  antl  chemists  when  studies  of  water  supplies,  sewer 
systems,  etc.,  were  desired.  At  the  end  of  his  time  the  University  of 
Illinois  had  established  a  sort  of  bureau  called  the  State  Water  Survey 
and  arrangements  were  made  for  that  agency  to  do  the  santiarv  engin- 
eering work  of  the  Board. 

No  quarantine  officers  were  steadily  employed  when  Dr.  h^gan 
began  and  none  were  so  employed  when  he  quit. 

During  his  time  a  lodging  house  inspection  service,  confined  to 
Chicago,  began  to  function  and  an  embryonic  diagnostic  laboratory 
was  established. 

A  .system  of  agents  through  whi}m  diphtheri.i  antitoxin  \\a^  dis- 
tributed free  throughout  the  State  was  estalilished.  .\  nioulhh  bulletin 
devoted  to  sanitation,  hygiene  and  the  practice  of  medicine  was  pub- 
lished with  consiclerable  regularity. 

This  was  the  machinery  which  the  ."^tate  h.'.d  built  up  b\-  1!)!.'!  for 
the  |.)rimar_\-  purpose  of  combating  disease.  It  had  exp.anded  enormous- 
1\-  since  19. m.     It  was  busv  all  of  the  time.     Its  mone\   resoiu'ces  had  in- 


174  rULil.U'    illCALTIl    ADMINISTRATION' 

creased  over  700  jjct  cent  Init  it  was  ])i)(iiiy  urtiani/cfl.  It  was  withmit 
form  ])ut  certainlN'  imt  \iiiil.  'I'lic  iimst  iiii]i()itaiit  cniuiihutinn  nf  the 
F.gan  reijiinc  to  |)iil)lic  lu-altli  st-rvice  in  the  State  was  tlie  enlti\  ation 
(if  tlu-  lialiit  aninnt;   k\i;"islat(irs  to  i^ranl   nKJuey   fur  tliat  ])nr|Mise. 

TtiE  Drakk  Rkciimk. 

After  a  lapse  of  a  little  nmre  than  a  year  fnmi  the  time  when  Dr. 
l'".gan  (lied  in  March,  lUl;!,  dniinL;  which  period  -Mr.  AnidS  Saw'_\er,  chief 
clerk  of  the  Board  for  many  years,  acted  as  secretary,  Dr.  C.  St.  Clair 
Drake  of  ChicaLji)  was  appointed  hy  (loxernor  Dunne  to  take  <.)\er  the 
executive  w  ( irk  nf  the  Stale  Fxiard  of  llealth.  Dr.  I3rake  was  appointed 
in  Alay  of  lUl  I  aii(.l  to(jk  active  charge  mi  the  first  of  June. 

Several  visits  prior  to  that  time  had  familiari/ed  him  with  the  situa- 
tion, h'evv  sij^nihcant  ch.anges  liad  taken  place  since  Dr.  h'-gan's  death. 
The  llnancing  (if  the  l>(iard  at  that  time  was  con<lncted  (Hi  the  folldwiiig 
basis.  Availalile  nmney  v\as  drawn  out  (if  the  .^tate  treasnrv.  placed  to 
the  credit  of  the  Hoard  in  a  hical  liank  and  drawn  updii  while  it  lasted 
fur  whatever  expenses  were  deenie(l  necessary  td  incur.  This  jiractice 
had  prevailed  for  IJ7  years.  \\  hen  the  nidiiey  apprnpri.ited  fdr  (irdinary 
expenses  was  g'one  the  Pxiard  either  stopped  functinning  in  sanitarv"  and 
hygienic  services  or  else  mana,v,ed  to  get  luild  nf  cdntin,L;ency  funds 
vvdiich  were  likewise  drawn  diit  in  lump  sums  and  placed  in  the  hank 
for  expenditure  as  nccasidU  demanded. 

E('or(/aiiiz(ilinii  ami  Hiiihict. 

\\'hen  Dr.  Drake  arrived  at  the  Ca])it(il  in  June  he  hrdught  witli  him 
a  plan  of  organizatidii,  the  hrst  ci  imprehensiv c  scheme  that  had  ever 
been  intr(i(luce(l.  Dr.  Drake  had  lieen  witli  the  (  hicaL;d  health  depart- 
nient  for  many  years.  It  was  well  organized,  lie  had  ohserved  the 
systems  employed  elsewhere.  He  ])atterne<l  his  own  jilans  of  organiza- 
tion after  that  which  prevailed  in  C  hicagd,  making"  such  inddilicatinns 
as  the  diriereiit  circumst.iuces  demanded.  h'dlldwing  this,  there  were 
bureaus  under  the  .'-^tate  I'mard  df  llealth  each  with  s])ecihc  duties  and 
responsibilitii's  and  each  alldlled  a  s|)ecihc  sum  of  nidney.  In  short  a 
budget  system  had  been  add]iled. 

Manifesilv  the  new  scheme  cmild  (iper.atc  as  planned  tn  diily  a  lim- 
ited degree  niitd  recognized  by  the  ( leneral  .Assembly  in  the  sha]ie  of 
appropriations  fur  full  time  |i(.'rsdnnel.  'khis  is  exactly  what  happened 
within   a   \  ear  after    Dr.    Drake   took   charge.      In  a   law   enacted   in   the 


PRESIDENTS 

ILlinois  State  Board   of   Hcaltk 


G(:oc^eW.Vcb5to,9It.D. 


J0lllt.#£rt  101)15011,1.0, 

/9/'t-i9ir 


lT(i  I'll'.I.IC    illCAl.TH    ADMIXISTUATIOX 

spring'  (if    IIM."),   makini;   a|)|)r()])riali(nis  for  tlie   State  Board   of   Health. 

these  per  aiimiiu  ilcnis  are  fouml : 

Executive  office   $1S,680 

Bui-eau  of  Medical  Sanitary  Inspection 16,300 

Bureau  of  Vital  Statistics 5,500 

Laboratory    (salaries)    2,640  . 

Laboratory    ( supplies )     9,684 

Laboratory  ( Branch  Laboratories )    3,600 

Vaccines,  Sera  and  Antitoxins 38.000 

Travel    21,750 

Lodging  House  Inspection 11,075 

Bureau  of  Sanitary  Engineering 10.850 

Miscellaneous  including  extra  help,  per  diem  for  Board  mem- 
bers,  rent,   etc 23,860 

Contingency    4,650 

Total   $166,589 

All  this  was  something  distinctly  new  in  Illinois  health  service.  It 
represented  a  sjilendid  step  toward  systematic  prosecution  of  sanitary  and 
hygienic  work.  The  most  significant  feature  was  the  provision  for  full 
time  employment  of  personnel  and  the  allocation  of  funds  for  specific  pur- 
poses. Under  each  bureau  the  per  annum  salaries  for  a  definite  number  of 
positions  were  itemized.  In  the  biux-au  of  medical  and  sanitai"y  inspection, 
for  instance,  there  were  listed  the  salaries  for  four  district  health  officers 
(this  is  the  first  ajjpearance  of  that  term),  one  epidemiologist,  three  dairy 
inspectors — two  j)art  time — and  four  clerks  and  stenographers.  The  bureau 
of  vital  statistics  had  a  registrar  and  a  clerical  statt  of  four  provided  for 
while  the  laboratory  drew  a  bacteriologist  and  messenger  with  extra  funds 
for  equipment.  For  the  bureau  of  sanitary  engineering  there  were  listed 
a  chief  and  two  assistant  sanitary  engineers,  one  stenographer  and  mis- 
cellaneous supplies.  For  the  executive  office  there  were  itemized  the  secre- 
tary, an  attorney,  a  clerical  staff  of  10  and  a  messenger.  This  force  was 
subject  to  duty  involved  in  both  branches  of  the  Board's  activities — those 
concerning  licensure  and  those  concerning  sanitation. 

Eilucdf iininl  I'rdjxif/diiila. 

Splendid  as  was  the  step  toward  organization  and  system.  Dr.  Drake's 
best  efforts  were  in  another  direction.  He  was  at  heart  an  educational  jn'opa- 
gandist.  The  faculty  for  stimulating  popular  interest  was  his  to  an  extra- 
ordinary degree.  This  faculty  he  put  to  work  at  once  after  coming  into 
State  health  service. 

At  the  Illinois  State  Fair  helii  at  .'^prin^lield  in  ilie  autumn  of  ]!n4. 
a  few  brief  months  after  his  a])])ointment,  Dr.  Drake  put  an  exhibit  in  the 
space  which  had  been  occupied  by  the  State  Board  of  Health  in  previous 
years  but  it  was  a  new  kind  of  exhibit.  It  attracted  the  public  eye  with 
sufficient  force  to  provoke  front  page  newspaper  comment.     The  exhibition 


PUBLIC   HEALTH    ADMINISTRATION  lii 

was  built  up  around  six  mechanical  models  of  ingenious  design  and  was 
graphTc,  impressive,  fascinating. 

Another  feature  of  the  exhibit  eiiuipnicnt  was  its  mobility.  It  could  be 
transported,  installed  and  dismantled  easily.  Year  after  year  it  increased 
both  in  size  and  popularity  and  was  displayed  many  times  in  alniDst  every 
county  of  the  State  with  the  exception  of  the  extreme  southern  ones. 

By  January  1915  the  monthly  publication,  which  had  been  allowed 
to  lapse  after  the  death  of  Dr.  Egan,  was  resumed  under  a  new  name, 
in  a  new  stvle  and  for  a  new  audience.     What  the  jiurpose  was  and  what 


ORGAniZATIOn    OF 
STATE    BOARD   OF    HEALTH 
1915 

STATE  BOARD  OF  MEALTO 

7    riemters 

fnlorcrment    S^rtST^Pr^  (« e 
^t    ^th   aid    of  crtro   help 

EXECLTTiVE  OFFCt 

LABORATORY 

BUREAU  OF 
VITAL  5TAT1SIK. 

5 

iUREAU  or  ncoiou.  a 

SAHTAIW  mSPECTOfT 

BUREAU   OF 
3AniTARV  EMGinttRinG 

LODGinG  MOUSE 

nsPEcnon  service 

Bocleriolocyst 

^^. 

|tnSirop»W' »yJ 

Fig.  10.    This  was  the  effective  strength  during  the  two  years  terminating 
on  June  30.  1917  when  the  State  Board  ot  Health  went  out  of  existence. 


subsequently  was  the  character  of  the  new  i)ul)licatioii  that  was  named 
HEALTH  NEWS  are  very  well  set  forth  on  the  title  ])age  of  the  first  edition 
in  these  words : 

Health  News  is  a  continuation  ot"  the  BULLETIN  which,  for  several  years, 
has  appeared  as  the  official  organ  of  the  Illinois  State  Board  of  Health.  The 
change  in  title  and  the  change  in  style  foreshadow  the  new  methods  and  new  aims 
of  the  publication.  The  Bulletin  sought  to  attain  better  health  conditions  through- 
out Illinois  by  the  discussion  of  more  or  less  technical  subjects  with  the  medical 
profession  as  its  audience  and.  in  addressing  sucli  an  audience,  the  Bulletin  very 
naturally  contained  many  details  of  the  activities  of  the  Board  and  much  material 
which  would  prove  of  interest  only  to  physicians  and  persons  of  technical  training. 


178  I'l'liLIC    HEALTH    ADM  INI.STUATION 

Health  Nt'ws,  with  tlie  same  general  purpose,  seeks  a  new  and  larger  audi- 
ence. It  hopes  to  bring  the  essential  facts  relative  to  "the  promotion  of  health  and 
the  prevention  of  disease"  to  the  men  and  women  of  Illinois;  to  reduce  the  tech- 
nical science  of  preventive  medicine  to  terms  of  practical  application  for  the 
individual  and  the  community. 

Health  News  is  merel.v  a  part  of  a  definite  campaign  ot  popular,  public  health 
education  contemplated  by  the  State  Board  of  Health.  This  program  includes,  aside 
from  this  monthly  publication,  the  use  of  a  public  health  exhibit  which  is  now 
being  employed  and  which  is  creating  much  interest  throughout  the  State.  There 
is  also  being  operated  a  bi-weekly  press  service  through  which  short,  readable 
public  health  articles  are  published  in  the  newspapers  of  Illinois.  The  various 
pamphlets  and  circulars  of  the  Board,  devoted  to  the  prevention  ot  the  .several  com- 
municable diseases,  to  the  care  of  infants  and  kindred  subjects,  are  being  rewritten 
and  made  more  acceptable  to  the  public  demand.  The  efforts  of  the  individual  com- 
munities to  increase  interest  in  public  health  affairs  will  be  encouraged  by  public 
lectures  by  members  of  the  State  Board  of  Health  and  the  office  and  field  staff  and. 
in  many  instances,  these  lectures  will  be  illustrated  by  nujtion  pictures  and  the 
stereopticon. 

The  policies  set  forth  in  this  expression  characterized  the  whole  Drake 
regime,  lie  followed  it  persistently  and  it  popularized  public  health  service 
in  the  Slate. 

By  autumn  of  l'J15  Dr.  Drake  had  struck  upon  another  means  of  large 
potentialities  for  stimulating  popular  attention  to  sanitary  and  hygienic  mat- 
ters. This  was  the  well  baby  conference.  At  the  State  Fair  in  that  year 
was  conducted  the  hrsl  baby  conference  in  which  the  state  government 
had  ever  participated.  :\s  a  magnet  for  attracting  public  interest  the  baby 
conference  was  more  than  a  match  for  the  mobile  exhibit.  (3ne  careful 
look  at  a  mechanical  model  satisfied  more  or  less  permariently  the  curiosity. 
Interest  in  a  baby  is  immortal.  The  idea  of  helping  him  to  keep  well  is 
appealing.  Looking  through  spacious  glassed  openings  at  phy.sicians  and 
nurses  busily  engaged  in  examining  babies  is  a  sight  of  which  the  eyes  never 
tire.  The  baby  conference  had  come  to  stay  and  to  grow.  Soon  it  w-as  a 
common  feature  of  local  fairs  and  other  community  events.  Stafif  members 
of  the  .':^tate  Board  of  Health  were  called  upon  lo  assist  in  this  work.  Thi- 
practice  added  a  cotisiderable  strength  to  the  ln;iltli  niachiiicry  since  it 
brought  the  idea  of  jireventive  medicine  directly  to  tlmttsiunl'-  n\  mothers 
through  personal  contact. 

Alotion  pictures  and  stcreoi)ticon  slides  were  not  overlooked  as  nieditmis 
through  which  to  stinutlate  public  iiUerest  in  health  matters.  In  llilii  a  few 
motion  [licture  films  were  purchased  and  a  loan  lilirary  started,  'i'his  grew 
in  popiil.irit\'  until  now  nearly  lOll  reels  are  maintained  in  the  library  and 
circulated  widely. 

The  popularity  of  the  exhibits  promoted  liy  1  )r  Dr.ikc  xion  led  to 
exjjansion.  Before  be  left  the  state  health  service  in  ID''!  the  sjiacc  allotted 
to  the  heahh  exhiliition  ,it  the  State  l'"air  embraced  more  than  I.OIH)  square 
feet  and  in  it  was  a  motion  picture  theatre,  specially  constructed  lialiy  e.x- 
amination  i[tt;irters  atid  a  score  of  liootbs.     The  mobile  exhibits  had  traveled 


PUBLIC    HEALTH    ADM  I  X  ISTKATIOX  179 

throughout  the  State  and  had  hccn  faxoiably  received.  Around  thcni  and 
the  exhibits  supplied  by  the  city  licahh  department  of  Chicago  and  other 
heahh  agencies  had  Ijcen  buih  a  nianinioth  exhibition  known  as  the  Pageant 
of  Progress  which  (h'ew  humh-eils  of  thousands  of  visitors  to  the  CoHseum 
where  il  was  staged. 

.\  (jroject  called  "Health  I'roniolion  Week"  was  another  nielhud  in- 
itiated l)y  Dr.  Drake  fcir  cultivating  public  thought  on  preventive  medicine. 
This  idea  materialized  in  a  slate-wide  program  in  the  spring  of  l!)l!t.  It 
was  a  new  thing  so  the  press  of  the  .State  gave  il  generoirs  space.  It  was 
perfectly  planned.  The  General  Asseml)lv  endorsed  it  with  a  joint  resolution. 
The  Governor  certified  that  the  movement  ])leased  him.  Endorsements  were 
secured  from  a  score  of  the  most  powerful  civic  and  professional  organiza- 
tions in  the  S'.ate.  A  specific  task  for  each  dav  was  descriljcd  in  the  pro- 
gram which  terminated  with  the  item  "Pageant".  The  idea  was  new  in 
the  h.ahh  iield  •-•(>  the  ]iress  contributed  sjjace  g^enerously.  Traveling  re]ire- 
sentatives  visited  practicallv  all  comnumiiies  in  the  State  effecting  local 
organizations. 

The  project  was  a  tremendous  success.  Few  if  any  other  deliberate 
attempts  to  create  juiblic  thought  on  health  matters  at  a  given  time  ever 
achieved  its  jiurpose  so  completely.  It  led  to  a  permanent  annual  e\'ent 
b)-  the  same  name  l)Ut  somewhat  difl'erent  in  character.  Health  Promotion 
Week  has  come  to  be  a  sort  of  instiiutidn  in  Illinois.  It  is  an  occasion 
looked  forward  to  by  health  workers  all  o\er  the  .State  as  a  time  for  starting 
new  cam])aigns  or  for  reporting  to  the  public.  It  is  a  sort  of  revival  project 
for  liic  d  health  workers. 

I  III  poi'taiit  Il(  (ilfli  Lans  Kiuutid. 

.\  number  of  iiuportant  health  laws  were  i>assed  during  the  Drake 
regime.  In  PH.")  a  satisfactory  vital  statistics  statute  came  into  being,  pro- 
viding for  the  first  time  the  legal  machinery  necessary  to  the  collection  of 
reasonably  complete  returns  id"  birtli  and  death  records.  .\t  the  same 
meeting  of  the  legislature  a  bill  known  as  the  (  .lackin  Law,  which  author- 
ized counties  to  levy  a  tax  and  spend  the  re\emie  therefrom  for  constructing 
and  maintaining  tuberculosis  sanitaria  was  passed  and  signed  bv  the  Gov- 
ernor. Still  am  ther  law  of  1!)].")  provided  for  the  establishment  of 
health  districts  in  one  or  more  adjacent  towns  or  road  districts,  making 
it  possible  to  lev\-  taxes  and  maintain  modern  local  health  organizations. 
Advantage  of  this  law  has  lieen  taken  in  (Juincv  and  Berwvn  while  a 
privately  endowed  health  department  serving  PaSalle,  r)ulesb\'  and  Peru 
exercises  legal  authority  under  it. 


ISO  PUBLIC   HEALTH   ADM  1  X  ISTUATION 

These  three  laws  had  a  tremendous  influence  over  the  puhHc  heaUh 
machinery  of  the  State.  This  is  especially  true  of  the  san-tarium  law.  It 
and  the  vital  statistic  statute  are  discussed  in  detail  in  another  chapter. 
The  district  health  law  appeared  to  have  come  int(.)  existence  more  as  a 
nieaiLs  of  legalizing  the  LaSalle,  Oglesby  and  Peru  organization  than  any- 
thing else.  It  has  never  been  regarded  by  State  health  officers  as  the  best 
plan  upon  which  to  promote  local  health  units.  To  make  it  apjily  in  more 
than  one  town  or  road  district  the  proposition  nuist  carry  by  poj)ular  vole 
in  each.  This  makes  it  very  difficult  to  work  on  a  county  basis  and  hence 
the  county  has  I)een  regarded  by  the  Department  as  the  most  practical  po- 
litical unit  in  which  to  develop  full  time  modern  health  dejiartments  for 
rural  ^-ervice.  The  larger  cities  are  legally  able  to  take  care  of  themselves 
in  health  matters. 

Neic  Rules  for  Ilaudlhifi  Coufagious  Diseases. 

One  of  the  very  important  things  that  Dr.  Drake  did  early  in  I'.M")  was 
to  revise  the  rules  and  regulatior.s  of  the  State  Board  of  Health  concerning 
communicable  disea.se.  Since  the  very  early  days  of  the  Board's  existence 
there  had  been  rules  re(|uiring  the  notification  of  certain  epidemic  diseases 
but  these  had  been  general  on  the  one  hand  and  there  had  existed  no  local 
machinery  through  which  they  could  be  enforced  on  the  other.  Dr.  Drake 
codified  the  rules  and  made  a  s])eciric  list  (if  re]iortal)le  diseases.  He  speci- 
fied a  time  limit  within  which  the  diseases  should  be  reported.  He 
specified  to  whom  they  should  be  rejjorted  locally — health  officer,  health 
commissioner,  chairman  of  the  board  of  health,  mayor,  village  president, 
supervisor,  county  commissioner,  etc.,  co^-ering  every  case.  These  officials. 
in  turn,  were  required  to  forward  the  reports  to  the  State  F>oard  of  Health 
within  specified  time  limits. 

The  rules  also  covered  matters  of  quarantine,  specifying  time  limits  for 
isolation  of  jiatients  and  thev  sjiecilied  sanitary  and  h\gienic  ])recautions 
that  were  recjuired  on  (piarantined  ]iremises. 

(iciiciiil  I'liiii  (iii'l  I'crsdinii'l. 

it  will  In-  ^een,  then,  that  Dr.  Drake  |)r()])ose(l  to  bring  sanitation 
and  hygiene  into  ]iopulai  fa\iir  through  educational  channels  and  to 
appl_\'  moilt-rn  disease  control  methods  as  rigidly  as  public  sentiment 
would  ]iermit  through  an  adecpiate  organization.  Prompt  notification 
of  comnnuiicable  diseases  was  essential  to  the  functioning'  of  the  State 
organizatiiin  >o  lar  as  e]iidemic  outbreaks  was  concerned,  so  he  ])ro- 
vided  for  this  continL;('ncy  with  bis  new  rules.  He  was  andiitions  to 
concentrate  all  State  health  work  mider  the  Hoard  of  Health.  This 
would   include   food,  drnL;s,  (lair\-   inspectinn,  tuberculin   testing   of  cattle 


PUBLIC    HEALTH    ADM  I  XISTRATIO.V  1X1 

and  stream  pnllutinn  Avhich  were  under  \'ariiius  boards  and  cunimis- 
sions.  He  was  e\'en  willing-  that  the  retjuhitiiin  of  medical  practice 
remain  under  the  State  ISoard  ol"  Health  l)nt  this  he  would  have  sep- 
arated intn  a  (lejiartment  of  its  own,  distinct  from  another  department 
that  would  function  only  in  the  field  nf  what  mi^ht  be  called  iH-eventi\e 
medicine. 

As  soon  as  the  lUl.j  approiiriation  law  became  effective  Dr.  Drake 
set  to  work  organizing  the  health  service  in  com]iliance  therewith.  This 
was  slow  for  several  reasons.  In  the  first  place  the  personnel  had  to 
be  employed  under  civil  service  regulations  and  that  took  time.  Sec- 
ondly,  it  was  difficult  to  locate  suitablv  trained  persons  to  fill  the  tech- 
nical ])ositions  at  the  salaries  proxided.  Furthermore  there  was  lack 
of  space  in  the  capitol  Ijuilding  to  house  the  new  machinery. 

By  early  spring  of  litjii,  however,  tlie  difficulties  had  l:)een  largely 
o\erc(inie  and  there  was  in  existence  the  lic.^t  organized  force  that  the 
State  liad  e\'er  employed  for  dning  straight  ])ublic  health  wcirk.  There 
were  fi\e  full  time  physicians  in  the  bureau  of  sanitary  and  me(lical 
inspection  each  assigned  to  one  nf  h\t^  districts  into  wliich  tlie  State 
had  been  dixided  for  that  ])iu'i)ose.  In  the  same  l)ureau  there  were  milk 
inspectors  and  a  clerical  staff.  There  was  a  bureau  of  sanitar\-  engineer- 
ing made  up  of  a  chief  and  two  assistant  engineers  and  a  stenograjiher. 
A  bureau  of  \ital  statistics,  headed  by  a  registrar  under  wIkjui  was  a 
corj)s  of  clerks,  was  functioning  and  had  already  ])ut  into  operation  the 
new  law  which  required  many  new  procedures.  There  was  a  central 
diagnostic  lal)oratory.  manned  by  a  small  staff,  located  in  Springfield 
and  two  l)ranch  laboratories,  the  latter  being  ojierated  on  a  contract 
liasis  with  [irixate  laboratories  already  in  existence.  The  agency  sys- 
tem for  the  distribution  of  biologies  now  made  easily  available  to  every 
(hictor  in  the  .State  diphtheria  antitoxin,  typhoid  ^■accine,  smallpox  vac- 
cine, silver  nitrate  for  the  ])revention  of  blindness,  mailing  containers 
for  laboratory  specimens  and  circulars  of  information.  In  tlie  central 
office  there  was  a  considerable  clerical  staff  that  (H\ided  its  time  between 
duties  relating  to  health  service  and  to  licensure.  There  was  the  educa- 
tional work  of  publishing  a  monthly  bulletin  and  supplying  copv  to  the 
press.  .Ml  this  was  a  splendid  organization  compared  with  what  had 
g'one  before. 

In  the  meantime  national  diplomatic  difficulties  with  Alexico  had 
led  to  a  military  complication  which  resulted  in  the  mobilization  c;if  the 
National  tluard.  This  incident  in\ol\ed  the  State  Board  of  Health  in 
camp  sanitation  activities  and  it  is  worthy  of  note  that  Governor  Dunne 
twice    dela}'ed    mol)ilization    orders    upon    the    recommendation    of    Dr. 


182  PUBLIC    IlKAI.TIl    ADM  I  XISI  RATION' 

Drake-  because  sanitary  facilities  were  iiici  unplete.  I'liis  was  an  expres- 
siiin  nf  ciinlidence  in  the  State  healtli  autln  irities.  ['"urthernKire,  the 
State  I'xiard  dl'  lU'alth  furnished  sniaili)ox  and  tyi)hoid  fc\er  \-accine 
with  which  the  trciups  were  iniuninized  against  those  diseases. 

With  the  new  \t-ar  nf  I'.ti;  cauie  the  I.owden  administration  with  its 
reorijauizaliiin  plan  that  prn]Hised  tn  substitute  a  few  departments,  each 
headed  b\  a  (hrecinr,  fur  the  manifnid  hoards  and  commissions  that  con- 
stituted the  Stale  l;i ivernnieut  and  to  put  all  governmental  activities  upon  a 
budget  system.  Xuthing  could  have  pleased  Dr.  Drake  better,  lie  had  an 
organization  scheme  already  started.  This  (ippdrtunity  allowed  him  tn  elab- 
orate on  it.  Me  presented  to  the  administration  a  plan  that  would  have 
retained  the  State  Board  of  Health  to  reign  over  two  great  departments — 
the  one  tn  dn  ])ublic  health  service  and  the  other  to  regulate  the  j^ractice  of 
medicine.  The  administration  clmse  to  drop  the  Bcjard,  make  two  dejjart- 
ments  to  carry  cm  the  wurk-  and  incnrpnrated  the  Drake  ]ilan  for  health 
service  into  the  C'i\il  .\dniinistrati\e  Lode  as  the  l)e])artment  nf  I'ublic 
Health  and  which  still  gn\erns  the  nrganizatinn  as  it  functi<ins  today. 

SIdlf  DrjKirtiiK'ut  (if  I'uhlic  llcdifli  Ornanizcd 

\\  hile  piil)hcit\-  was  the  wnrk  in  which  Dr.  Drake  excelled  his  -suc- 
cess in  that  helil  was  nnt  the  most  important  event,  so  far  as  the  pubhc 
health  machinery  was  concerned,  that  transpired  during  his  administration. 
The  most  signihcant  single  event  was  the  adojition  of  the  I.owden  Civil 
Administrative  Code  by  the  State  government  in  I!M,.  This  con\erted 
the  State  Board  of  Health  into  two  departments,  the  one  to  devote  itself 
henceforth  io  sanitary  and  hygienic  work  alone  and  the  other  to  handle 
all  matters  relating  to  licensures  not  only  of  physicians  but  of  all  other 
])rofessions  that  required  it.  The  State  Department  nf  I\iblic  Health  was 
created  by  this  division  and  it  began  to  funclinn  in  the  held  of  sanitation 
and  hygiene  with  an  appropriation  of  nearh-  nne  half  million  dollars  for  the 
hrst  biennium,  ;i  sum  far  in  excess  of  an\tbing  that  had  ever  been  granted 
to  the  State   Bn.ird  nf    Health. 

The  adnptinn  of  the  (_i\il  .\dministrative  Code  divorced  public  health 
si'i  vice  anil  the  regidalinn  nf  medical  practice.  It  established  straight  health 
wnrk  as  nne  nl  the  major  de])artments  nf  the  State  gn\ernment  and  bv 
lining  so  lirnught  tn  ;in  end  the  secnnd  period  in  the  de\elnpnient  of  |)ulilic 
health  machinery  in  Illinois. 

The  new  Stale  I  )ep,irlnunt  of  I'ublic  Health  which  came  into  legal 
existence  |ul\-  1,  I'.M;,  fell  In  ir  to  all  the  |)ul)lic  health  duties,  powers  and 
responsibilities  that  were  fnrmerK  vested  in  the  Slate  Pioard  of  I  lealth  and 
had  new  ones  added.  I'nder  ihe  old  law  Ihe  res|)onsibility  for  policies,  rules, 
regulations,  etc.,  was  in  a  boanl  of  seven  members.     Lndcr  the  new  it  was 


lOM 


Prank  O.  Lowden,  Governor  of  Illinois, 
1917-1921,  whose  Civil  Administrative  Code 
brought  an  end  to  the  State  Board  of  Health 
and  put  in  its  place  the  State  Department  of 
Public  Health. 


18-i  ruiii.ic  mcALTii  administkatiox 

in  one  man,  the  dirc-ctur  ul  the  department.     The  Code  prnvides  fur  an  ad- 
visory board  Inil  its  f unctions,  in  a  lesral  sense,  are  literally  what  llii'  name 

.  .  t  ■ 

implies — advisory.     All  decisions  must  ultnnately  be"  made  by  the  director 

and  upon  him  rests  all  the  responsibility  of  the  department. 

The  powers  and  duties  of  the  State  Department  of  Public  ilealih  under 
the  Civil  .Administrative  Code  are,  briefly  as  follows: 

(h'licrdi  I'hni  (iiiil  I'l  rsoinicl . 

"I.     Prescribed  by  the  Civil  Administrative  Code. 

1.  To  have  general  supervision  of  the  health  and  lives  of  the  people. 

2.  To  advise  relative  to  public  water  supplies,  water  purification  works, 
sewerage  systems  and  sewage  treatment  works. 

3.  To  exercise  supervision  over  water  and  sewerage  nuisances  and  to  make 
rules  concerning  same. 

4.  To  conduct  sanitary  investigations  for  the  improvement  of  public  health. 

5.  To  investigate  nuisances  and  questions  affecting  public  health. 

G.  To  maintain  chemical,  bacteriological  and  biological  laboratories  and  to 
conduct  examinations  of  milk,  water,  sewage,  wastes,  etc. 

7.     To  diagnose  diseases  when  necessary  for  public  protection. 

S.  To  purchase  and  distribute,  free  of  charge,  diphtheria  antitoxin,  typhoid 
vaccine,  smallpox  vaccine  and  other  preventive  and  curative  agents. 

9.  To  collect  and  preserve  useful  information  relative  to  public  health. 

10.  To  investigate  the  causes  of  disease. 

11.  To  keep  informed  of  the  work  of  local  health  officers  and  to  assist  local 
health  authorities  in  the  administration  of  health  laws. 

12.  To  inform  the  general  public  in  matters  of  health. 

13.  To  enlist  the  cooperation  of  physicians  and  health  agencies  to  improve 
the  public  health. 

14.  To  make  inspections  of  the  charitable,  penal  and  reformatory  institu- 
tions and  normal  schools  and  to  inspect  all  hospitals  and  other  public  institutions 
and  to  report  their  needs  to  public  authorities. 

15.  To  print,  publish  and  distribute  documents,  bulletins,  etc..  relative  to 
public  health. 

IC.  To  exercise  the  rights,  powers  and  duties  vested  in  the  former  State 
Board  of  Health. 

II.  Powers  under  the  State  Board  of  Health  Act. 

1.  To  declare,  modify  or  relax  quarantine. 

2.  To  prescribe  rules  and  regulations  for  sanitation. 

3.  To  regulate  the  transportation  of  tlie  dead. 

4.  To  investigate  the  cause  of  communicable  diseases,  especially  during  epi 
demies,  and  to  take  proper  measures  to  suppress  dangerously  communicable  dis- 
eases when  local  authorities  fail  to  act  promptly  and  efficiently. 

5.  To  prepare  forms  for  the  record  of  births,  marriages  auil,  deaths. 

6.  To  inspect  lodging  houses,  boarding  houses,  inns  and  hotels  in  cities  of 
100,000  population  or  more. 

7.  To  prescribe  rules  and  regulations  concerning  the  distriljution  and  sale 
of  antitoxin. 

III.  Duties  under  the  Vital  Statistics  Act. 

1.  To  keep  records  of  births,  stillbirths  and  deaths. 

2.  To  establish  registration  districts  and  to  appoint  local  registrars. 

3.  To  prescribe  the  form  of  register  or  record  to  be  kept  by  cemeteries  and 
to  proscribe  all  forms  of  reports  for  births,  stillbirths  and  deaths. 

4.  To  supply  local  .registrars  with  blank  forms  and  to  issue  instructions  to 
secure  uniform  enforcement  of  the  Act. 

5.  To  arrange  and  permanently  preserve  certificates  of  births,  stillbirths 
and  deaths. 

6.  To  luiblish  annual  reports  of  births  and  deaths. 


PUBLIC    HEALTH   AD.M  I  X  ISTKATIOX  1  So 

7.  To  certify  to  county  clerks  tlie  luimber  of  births,  stillbirtlts.  and  deatlis 
registered  in  the  county. 

S.     To  furnish  certified  copie.s  of  records  of  any  births,  stillbirths  or  deaths. 

IV.  Duties  under  the  Ophthalmia  Neonatorum  Act. 

1.  To  provide  all  obstetricians  with  a  prophylactic  for  opthalmia  neonatorum. 

2.  To  publish  and  distribute  literature  on  the  dangers  from  ophthalmia 
neonatorum. 

.3.     To  report  violations  of  the  Act  to  prosecuting  attorneys. 

V.  Duties  under  Miscellaneous  Acts. 

1.  The  County  and  Township  Board  of  Health  Act  authorizes  the  depart- 
ment to  discharge  the  duties  of  local  Boards  of  Health  in  case  of  failure  or  refusal 
to  act  in  time  of  epidemic. 

2.  The  Sanitary  Health  Districts  Act  requires  the  department  to  conduct 
competitive  examinations  for  health  ofiicers. 

3.  The  Barbers'  Act  requires  the  department  to  approve  sanitary  rules  for 
barber  shops. 

4.  The  Lodging  House  Act  requires  the  department  to  formulate  sanitary 
rules  for  inns,  hotels  and  lodging  houses. 

5.  The  Occupational  Diseases  Act  requires  the  department  to  furnish  blanks 
for  e.xaminations  for  vocational  and  occupational  diseases  and  to  transmit  such 
reports  to  the  Division  of  Factory  Inspection. 

6.  The  Rabies  Act  requires  the  department  to  select  institutions  for  I  he 
treatment  of  poor  persons  suffering  from  rabies. 

7.  An  amendment  to  the  Military  and  Naval  Code  authorizes  the  department 
to  assume  sanitary  and  health  supervision  over  zones  surrounding  military  camps, 
ranges  or  buildings  used  for  military  purposes." 

For  the  ptirposes  enumerated  the  General  Assembly  granted  the  State 
]  Jeparmient  nf  1 'ublic  Ile;dtli  $  I  l:i.'.' 1\^  with  which  In  tunctinii  durini;  its 
first  hicnniuni  and  the  (nivernur  a])puintc<l  Dr.  C.  ."^t.  Clair  Drake  as  the  hrst 
director.     Dr.  George  Thomas  Palmer  was  nia<le  assistant  director. 

Seven  divisions  were  named  in  the  I!H7  appropriation  iaw  with  prox'ideil 

funds  for  each.     The  names  of  ihe  (li\isiiins  and  the  number  and  character 

of  the  persdunel  jirovided  for  were  as  tnlluws: 

I.      General  Office. 
1  Director. 
1  Assistant  Director, 
1  Chief  Clerk. 

5  Clerks  and  Stenographers. 
1   Messenger. 

II.     Communicable   Diseases. 

1   Chief  and  Epidemiologist.  M.   D.. 

1  Supervisor  of  Field  Service, 
r,  District  Health  Officers. 

2  Public  Health  Nurses. 

2  Quarantine  Officers, 

i)  Clerks  and  Steno.graphers. 

III.      Tuberculosis. 
1   Chief. 

n'.     Sanitation. 

1   Chief  Sanitary  Engineer, 

3  Assistant  Engineers, 

1  Supervisor  Surveys  and  Rural  Hygiene, 
1  Farm  Sanitation  Advisor, 
3  Clerks  and  Stenographers. 


181)  ruTiLic  iii:A[.Tn  adm  ixistnation 

V.      Diagnostic   Laboratory. 

1   Chief  Hat-teriologist  and  PatliolOKist. 

1    Bacteriologist. 

1   Laboratory  Helper. 

\1.     Vital  Statistics. 
1   Registrar. 
1  Assistant  Registrar, 
9  Clerks. 

VII.      Lodging   House   Inspection. 

1  Superintendent, 
!i   Inspectors. 

2  Clerks  and  Stenographers. 

The  Civil  .Adniiiiistrative  Code  made  possible  a  de|iartniein  fcir  health 
wurk  only.  Dr.  Drake  organized  that  department  in  a  way  that  gave  it  the 
capacity  to  partiei])ate  in  practically  every  phase  of  pnhlic  health  service  ;ui(l 
to  extend  its  activities  to  all  ])arts  of  the  Stale.  The  rules  and  regulations 
[lertaining  to  morhidity  reports  and  ([uarantine  which  Dr.  Drake  had  ]int 
into  effect  in  l'.M-"i  linked  together  the  State  and  local  health  machinery  in 
a  tiniform,  workable  manner.  The  vital  statistics  law  of  I'.il.'i  provided  a 
satisfactory  means  (jf  collecting  birth  and  death  reports,  llealth  had  be- 
come popular  through  the  educational  activities  of  voluntary  and  ot^cial 
organizations.  The  stage  was  all  set  for  the  .^tate  to  embark  upon  a  splendid 
program  of  disease  control  and  prevention.  ( )n  July  1,  I'M],  the  law  which 
established  the  new  order  (if  things  became  etTective. 

War  Activities. 

A  new  contingency  develo])ed  in  lull  when  the  nation  had  become  em- 
broiled in  the  W'cndd  \\'ar  a  few  months  before  the  new  health  jirogram 
w.as  schecluled  to  start.  This  had  a  profound  influence  over  every  State 
go\ernmental  function.  It  brought  new  health  problems  for  the  new  State 
health  agencv  to  sohe.  .\  number  of  new  military  camps  sprang  up  over- 
night, almost.  an<l  old  ones  t<.iok  nn  new  life.  This  resulted  in  congested 
population  at  points  where  sanitary  facilities  were  extremely  iuade(|uate 
giving  rise  to  grave  he.illh  dangers.  Social  hygiene  became  a  problem.  In- 
dustries, such  ;is  coal  mining,  started  to  operate  at  high  speed  and  thus 
attracted  an  inthi.x  of  labor  in  many  communities  and  thereby  introdticed 
unusual  health  hazards.  The  call  to  arms  beg.an  at  once  to  deplete  the  slat'ts 
of  organizations  of  ;ill  kinds  and  the  newly  created  health  (le]iartment  did 
not  escape.  Salaries  ;md  wages  went  soaring  .above  the  ordiuar_\-  in  all  tlex- 
ible  concerns  but  for  the  health  (le])artment  the  maxinuim  rate  of  pay  for 
every  position  was  specified  by  law  and  the  legislature  would  not  meet  again 
for  two  year.s. 

Under  these  cmiditii  n<  the  ch.aracter  and  volume  of  public  health  service 
was  considerablv  tlilVerent    from  what  mi^bt  otherwise  h:ive  been  the  case. 


PUBLIC    HEALTH    ADM  I  X  ISTKATK  ).\  187 

Instead  of  deliberately  proiuotin^-  ci intact  with  local  ]jeace  time  machinery  it 
was  lit  primary  importance  to  line  n])  with  the  military.  Sanitary  zones 
ahnnt  the  camjjs  and  cantonments  were  established  and  in  these  were  con- 
centrated most  of  the  staff  of  the  department.  Careful  sanitary  surveys 
were  undertaken  in  nearly  all  of  the  communities  located  near  military  posts 
and  in  a  numljer  of  the  minini;-  towns.  Thus  the  State  Department  of  Public 
Health  found  itself  under  wartime  pressure  in  a  way  considerably  different 
from  what  had  been  anticipated.  Instead  of  going  deliberately  into  local 
communities,  making  contact  witii  local  officials,  investigating  water  and 
sewer  systems,  promoting  birth  and  death  registration,  stimulating  close 
observance  of  quarantine  and  notification  rules  and  regulations  and  encourag- 
ing the  establishment  of  efficient  local  health  organizations,  the  field  staff 
was  largely  concentrated  in  the  immediate  vicinity  of  military  camps  and 
busily  engaged  in  handling  the  emergency  problems  there. 

.\nother  event  that  modified  both  the  course  of  public  health  service  and 
the  function  of  its  machinery  was  the  outbreak  of  epidemics  of  infantile 
paralysis  in  1916  and  111  IT.  The  infectious  natvu-e  of  the  disease  made  it  a 
public  health  problem.  Its  crippling  character  made  it  the  subject  for  sjje- 
cialists.  To  meet  the  situation.  Dr.  Drake  arranged  for  a  member  of  his 
medical  staff.  Dr.  C.  W.  East,  to  go  to  Harvard  Medical  College  for  a  spe- 
cial course  in  infantile  paralysis. 

Infantile  paralysis  in  epidemic  form  was  a  new  experience  to  many 
physicians  and  its  wide  prevalence  made  it  of  considerable  public  concern. 
This  situation  created  a  demand  for  instructive  lectures.  Dr.  East  was 
assigned  to  the  task.  He  toured  the  State,  disseminating  the  knowledge  he 
had  gained  at  Harvard,  illustrating  much  of  it  with  lantern  slides. 

The  lectures  led  to  a  demand  for  clinics.  Many  jihysicians  wished  to 
bring  patients  in  order  to  establish  a  diagntjsis  and  for  technical  advice  con- 
cerning s])ecial  cases.  Parents  wanted  to  bring  their  children  who  were 
afflicted.  .Accordingly  clinics  were  established  at  various  points  throughout 
the  State  and  soon  absorbed  practically  all  of  the  strength  of  the  division  of 
child  hygiene  which  had  but  a  limited  stall.  Thus  instead  of  devoting  its 
strength  largely  to  edttcational  acti\itirs  the  Department  found  itself  labor- 
ing with  an  acute  problem  that  invoKx-d  clinical  service. 

Venereal  diseases  constitute  another  subject  that  moditieil  the  course  of 
public  health  service  in  the  State.  Cnder  >tress  of  the  W  ar  the  federal  gov- 
ernment launched  against  venereal  dise;ises  a  tremendous  program  which 
reached  every  soldier  in  the  army  and  spread  over  into  the  civilian  population 
through  the  state  governments.  .Since  drying  up  the  source  of  infections  is 
a  basic  activity  in  this  field  the  federal  government  appnipriated  large  sums 
for  the  establishment  of  clinics.     The  iilan  of  the  federal  government  antici- 


188  I'ur.i.u'  iii;ai.tii  admixistkatiox 

])aicil  hdili  cilucaliiiiial  and  curativt-  activity.  It  ])r(i])(ise(l  to  funii>h  iiuiney 
witii  which  ti)  start  ihc  wurl-:  as  a  ilcnumstratinn  and  then  U>  witinh'aw  as 
state  and  local  agencies  took  owr  the  matter. 

Illinois  joined  in  the  plan  and  added  a  division  of  social  hyt;iene  to  the 
organization  of  the  .State  1  )e|)arlnient  of  I'nhlic  Health  on  July  1,  11)18. 
Funds  which  were  ])rovided  1)\'  the  federal  government,  became  available 
November  1  of  that  year  and  the  new  division  started  to  function  at  that 
time.  Within  a  year  five  clinics  had  been  established  at  as  many  different 
])oints  in  the  State.  These  were  of  a  jiermanent  character,  the  equipment 
and  the  pay  of  the  director,  who  was  always  a  local  physician,  were  furnished 
out  of  funds  allotted  to  the  State  by  the  federal  g(ivernment. 

l'ltimatel\'  the  number  of  clinics  grew  to  more  than  a  score  and  the 
State's  go\ernnient  pr<i\ided  funds  for  continuiug  the  work.  An  appropria- 
tion of  $111(1,0(1(1  for  that  ])urpose  was  luade  by  the  General  Assembly  in  1919. 

Here  again  the  .Slate  Department  of  Tublic  Health  found  itself  involved 
in  ;i  task  that  rei|uired  clinical  service  in  order  to  fulfill  the  requirements  of 
its  program. 

These  clinical  activities  are  important  because  they  have  been  used  to 
promote  misunderstandings  and  conflicts  between  the  medical  jjrofession  and 
the  State  health  officials. 

If  the  great  Wdrld  War  frustrated  the  carefullv  devised  program  for 
jjublic  health  service  in  Illinois  during  the  period  of  that  emergency  it  pro- 
duced compensating  influences.  The  \\  ar  gave  to  sanitarians  the  opporttmity 
of  an  age  of  marvelous  achievement.  Soldiers  were  being  mobilized  in  great 
numbers  and  were  subject  to  rigid  disci])line.  The  civilian  population  was 
subject  to  unusual  demands  and  was  in  a  mental  attitude  that  made  easy  the 
practical  application  of  official  dictates  and  suggestions  in  all  fields  of  activity. 
Health  was  recognized  by  everybody  as  a  predominating  factor  to  success 
in  the  jirosecution  of  the  War. 

Sanitari;ms  were  not  slow  to  take  advantage  of  the  situation.  Every 
soldier  .and  e\er\'  sailor  was  xacciiialed  ;igainst  stnallpox  and  against  typhoid 
fe\er.  b~ver\  liooper  heard  ;i  lectuie  on  social  hygiene,  ^^'here  safe  water 
supply  s\stems  were  not  ;iv;iil;il)le  the  troojis  dr.ank  water  from  Lister  bags 
that  was  well  clilorinated.  Wherever  at  .ill  practicable  water  and  fly  tight 
latrines  were  constructed  for  troops.  Food  supjilies  were  rigidly  inspected. 
Sanitarv  officers  inspected  kitchens  often.  .Medical  officers  inspected  the 
men  frequently. 

These  were  new  things  to  the  great  m.ajority  of  soldiers  who  still  cher- 
ished the  idea  tli.at  dead  .animals,  maloderous  gas  and  filthy  alleys  gauged  the 
vo'ume  of  work  re([nired  of  ;i  he.alth  officer.  These  new  ideas  were  carried 
back  home  with  the  soldiers. 


PUBLIC    HEALTH   ADMINISTRATION  189 

In  the  meantime  the  federal  agencies  at  \\'ashintjton  were  busy  pro- 
moting health  programs.  The  childrens'  l)ureau  had  been  created  and  had 
stimulated  a  lut  of  popular  interest  by  carrying  out  a  national  baby  week 
project.  An  inter-departmental  social  hygiene  board  had  been  created  and 
given  plenty  of  money  with  which  to  prosecute  a  vigorous  anti-venereal  dis- 
ease campaign  among  ci\ilians. 

Post-War  Acfirifics. 

Thus  when  the  Illinois  General  Assemblv  met  in  1!)19  it  looked  with 
greater  favor  upon  public  health  jjrograms  than  many  such  bodies  had  done 
in  the  past.  This  time  Dr.  Drake  was  alile  to  get  an  increase  in  the  biennium 
appropriation  of  $182,698  above  that  two  years  before.  Of  the  increase 
$100,000  went  to  the  support  of  the  division  of  .social  hygiene,  created  a 
few  months  earlier  through  federal  resources.  The  remainder  went  to  the 
creation  of  four  new  small  divisions.  These  included  the  divisions  of 
biologic  and  research  laboratories  (which  were  from  the  outset  combined 
with  the  diagnostic  laboratory  for  practical  purposes),  child  hvgiene  and 
public  health  nursing,  surveys  and  rural  hygiene  and  public  health  in- 
struction. All  of  these  divisions  except  that  of  the  biologic  and  research 
laboratory  had  actually  come  into  being  on  a  small  scale  in  1917  through 
a  legitimate  manipulation  of  the  funds  appropriated  for  the  Department,  hut 
the  1919  General  Assembly  was  the  first  to  recognize  them  officially. 

This  gave  the  State  a  well  rounded  puliHc  health  organization.  The 
total  appropriation,  which  amounted  to  less  than  a  nickel  per  capita  per 
year,  was  not  as^  unstinted  as  that  which  prevailed  in  some  states.  Hut  it 
was  nnich  larger  than  anything  that  had  gone  before  in  Illinois  and  there 
was  now  authorized  by  law  a  staff,  howexer  small,  to  function  in  jiractically 
every  department  of  the  public  health  field. 

While  applying  an  organization  plan  and  budget  system  to  the  (itticial 
State  health  machinery  Dr.  Drake  did  not  neglect  either  national  or  local 
agencies  for  adding  strength  to  the  public  health  movement.  He  maintained 
the  favorable  contacts  that  had  been  established  with  what  were  now  great 
national  organizations  and  made  new  ones  whenever  desirable  opportunity 
arose. 

W  ithin  the  State  Dr.  Drake  injected  life  into  the  legallv  established  local 
health  machinery — at  least  so  far  as  rejiorting  communicable  diseases  was 
concerned.  There  were  laws  that  provided  local  health  machinery  in  every 
community  of  the  State,  naming  specific  officials  for  the  responsibilitv  ex- 
cept in  cities  and  villages  where  the  appointment  of  boards  of  healtli  was 
authorized.  There  was  another  law  requiring  all  police  and  other  officials 
to  aid  in  carrying  out  the  rules  and  regulations  of  the  State  health  officials. 


DIRECTORS 

State  Depautmeat  of   Public  Health 


1^ 


m 


C.StClaicDciiiJc/ 

/&/7    -    1921 


.D. 


!9'Z1  - 


C.  St.  Clair  Drake.  M.  U. 
V.  ST.  CLAIR  DRAKE,  Chicago:  born  January  2?,.  1S70.  St.  Thomas.  Ontario. 
Graduated  Chicago  Homeopatliy  Medical  College,  1891.  Statistician  Chicago 
Healtli  Department,  1895-1914.  Member,  secretary  and  executive  officer.  State 
Board  of  Health.  1914-1917.  Secretary,  Conference  of  State  and  Provincial  Health 
Authorities,  1919-1922.  Director,  State  Department  of  Public  Health,  1917-1921. 
Member  numerous  medical  and  extra-governmental  organizations. 


Isaac  D.  Rawlings,  M.  D. 
ISAAC  D.  RAWLINGS,  Chicago;  born  April  29,  1869,  Carrollton,  111.  B.  S.  and 
M.  S.,  Illinois  College  at  Jacksonville,  1890  and  1895  respectively.  M.  D.,  North- 
western University  Medical  School,  1893.  Two  years  of  graduate  medical  study 
in  the  universities  of  Vienna.  Berlin,  London  and  Dublin.  Appointed  instructor 
in  bacteriology  and  director  of  the  bacteriological  laboratory  in  Northwestern 
University  Medical  School  in  1895.  From  1S97  to  1918  held  various  positions  on 
faculty  at  Northwestern  University  Medical  School.  Medical  inspector,  Chicago 
Health  Department,  1899-1904;  assistant  chief  medical  inspector,  1904-1921.  Di- 
rector State  Department  of  Public  Health.  1921  to  date.  Member  numerous 
organizations. 


PUBLIC    HEALTH    ADMIXISTRATIOX  11)1 

Under  these  laws  Dr.  Drake  found  ample  authority  tor  specifying  certain 
persons  in  every  community  who  were  to  receive  reports  of  communicable 
diseases  and  to  transmit  them  to  the  State  health  officer.  He  had  field  stafT 
sufficient  to  stimulate  the  operation  of  this  process.  Dr.  Drake  also  got 
himself  appointed  collaborating  epidemiologist  of  the  U.  S.  Public  Health 
Service.  This  gave  him  the  privilege  of  supplying  local  health  officers  with 
postage  free  cards  for  making  reports.  Then  by  1!M'.)  the  process  of  com- 
municable disease  reporting  was  functiunrng  in  a  reasonably  satisfactory 
degree.  The  vital  statistics  law  of  IDl.j  had  created  local  registrars  in  ])rac- 
tically  all  townships  in  the  State  and  brought  into  operation  new  local  ma- 
chinery as  well  as  greater  facilities  in  the  collection  of  birth  and  death 
re])(u-ts. 

Outside  of  official  circles  the  old  conference  l^etween  State  and  Idcal 
heakli  officers  was  revived.  This  time  it  included  extra  governmental  agen- 
cies and  took  on  the  title  of  "Illinois  Public  Health  and  Welfare  Assucia- 
li(in."  This  was  organized  as  a  means  of  bringing  together  all  the  pulilic 
health  agencies  in  the  State  so  as  to  coordinate,  as  much  as  possible,  the  work 
of  all,  and  to  kei'p  some  uniformity  of  practice.  The  organization  never 
developed  vitality  emaigh  to  create  a  significant  infiuence  over  matters  in 
the  State. 

The  great  influenza  epidemic  in  ]'MS  brought  into  local  service  a  large 
number  of  public  health  nurses  in  the  State  who  owed  allegiance  to  the 
American  Red  Cross  and  the  Illinois  Tuberculosis  Association.  These  nurses 
found  such  high  favor  in  comnnmity  life  that  they  became  permanent  in 
manv  places  and  constituted  a  very  large  factor  in  the  ])ublic  health  machin- 
ei\'  of  the  State.  In  1  !•".'(!  a  plan  for  effecting  a  close  cooperation  between 
all  of  these  public  health  nurses  under  the  general  supervision  of  the  State 
Department  of  Public  Health  was  perfected  when  Dr.  Drake  managed  to 
secure  a  signed  working  agreement  between  the  agencies  concerned.  This 
agreement  was  based  on  a  national  ]5olicy  adopted  by  a  conference  between 
the  National  American  Red  Cross,  the  National  Association  for  the  Study 
and  Prevention  of  Tuberculosis  and  the  Conference  of  State  and  Pro- 
vincial Health  Authorities.  It  held  great  ])ossibililies  for  extending  the 
.State's  health  machinery  in  ;i  s])lendi(l  way  but  ne\er  accomplished  its  full 
purpose  becHUse  ;i  State  su|iervising  nurse  was  never  employed  with  regu- 
larity enough  to  di'xelop  and  carr\   out  a  significant  program. 

I  here  w  a>  also  a  i)lan  to  conduct  schools  ol  various  >orts — one  s\stem 
for  local  health  oftict'rs  at  regional  points  and  another  for  ])tiblic  health 
nurses.  The  ])lan  for  the  latter  was  to  hold  the  school  at  S]>ringlield  during 
the  summer  when  field  work,  ])articularly  in  the  schools,  w.as  light.  Xeilher 
jiroject  ever  grew  into  anything  of  magnitude  or  permanence. 


19'^  ITIiMC     111;. \1. Ill     ADM  I  NISI  NATIIIX 

With  all  (if  llic  s]ilriuli(l  ]inii;iH->s  in  (ir^anizaliini  and  magnitude  nf 
service  since  ll'l  1  llieri-  was.  at  the  end  ol"  the  Drake  it-mux'  in  l-'el)ruarv 
1!)31,  a  distinct  lack  of  ccxjrdinatiim  hetween  the  varinus  divi>i()ns  in  tjie 
State  Department  uf  I'nhlic  1  lealth.  It  was  iidt  innisiial,  tdr  instance,  for  a 
new  staff  nienilier  in  he  with  the  l.)t-i)artnienl  for  niontiis  hefore  he  knew 
the  other  divi>ion  chiefs  with  whom  he  was  supposed  to  work.  A  district 
liealth  sujierintendent  minlit  \isit  a  town  lime  and  again  where  some  recal- 
citrant local  registrar  olistiucted  jirompt  and  complete  returns  of  vital  statis- 
tics without  knowing  of  the  dilVicnlty.  The  field  staff  did  not  always  know 
that  the  l)e|iartment  operated  a  free  motion  ])icture  library  or  that  Health 
News  was  availaljle  free  to  any  citizens  of  the  State  who  wantetl  it.  The 
niachinerv  for  collecting  and  compiling  vital  statistics  was  all  set  up  and 
functioning"  more  or  less  satisfactorily  hut  no  comprehensive  mortality  sta- 
tistics were  forthcoming  nor  had  the  ."-^tate  been  admitted  to  the  L'.  S.  hirtli 
registration  area. 

hurthennore.  Dr.  Drake  never  felt  the  need  (.)f  official  advisory  council 
in  determining  policies  and  pro.grams.  The  Civil  Administrative  Code  jiro- 
vided  for  an  Advisory  Board  of  five  members.  Xone  was  ever  a])])ninted 
during  Dr.  Drake's  time  as  State  Director  of  Health.  .\  staff  meeting  of 
division  heads  was  never  held.  Husiness  with  each  was  transacted 
indixidually. 

The  divisions  were  located  in  half  a  dozen  different  places.  C)ne  was 
in  the  arsenal,  another  occupied  rented  quarters  down-town  in  .Springfield, 
some  were  on  one  floor  and  some  on  another  in  the  State  House.  Division 
chiefs  made  no  reports  of  their  activities  except  for  copies  of  correspondence 
and  the  annual  re])ort.  Discipline  concerning  work  hours,  time  off,  etc.,  for 
enijjloyes  was  a  matter  for  the  chief  clerk  to  keep  u]>  with  if  he  could. 

Even  Health  Nezvs  fell  into  the  most  irregular  publication  although  the 
newly  created  Division  of  Public  Health  Instruction  had  the  prei)aration  of 
this  bulletin  as  a  princi])al  function.  In  early  December  of  I'.IPI  ;i  Chicago 
nevvs]japer  columnist  humorously  observed:  "Xow  come  to  b.-md  the  (  )c- 
tober  and  Novembt'r  numbers  of  Doc  Drake's  'Illinois  Health  .\'e\vs.'  There 
is  a  chance  for  the  printer  to  catch  u|)  this  year,  so  here's  ho|iing  for  the 
Dect-mber  number  before  Jan.  1."  When  Dr.  Drake  left  the  Department  in 
h'ebruarv  r.i".M.  Hcallli  A'iTi'.v  was  fully  six  months  behind,  according  to 
records  in  the  oHice. 

SminiKini. 

When  Dr.  Drake  cann'  to  the  Capil.al  as  the  State's  chief  health  oflicer 
he  found  a  r.oar<I  of  Health  clixiclinj;  its  time  between  regulating  the  jiractice 
of  medicine  ,and  doiui;  sanitar\  and  b\i;ienic  work  -.about  two-thirds  to 
the   f(jrmer  .and  one  to  the  latler.     When  he  left   there   w.as  a  Sl.ale    Depart- 


PUBLIC    HEALTH    AD.M  I  X  ISTKATIOX  lil3 

nient  uf  I'uhlic  Health,  heack-d  Ijy  mie  man  who  was  responsible  lur  it--  puli- 
cies  and  activities,  which  devoted  its  entire  resources  to  straight  piililic  health 
service. 

At  the  heginning  of  Dr.  Drake's  tenure  practically  all  the  field  personnel 
of  the  State  Board  of  Health  was  on  a  per  diem  employment  basis  and  there 
was  nothing  in  the  way  of  specialized  iK-ad(|uarters  service  Init  a  smaU  diag- 
nostic laboratory,  a  small  staff  for  handling  vital  statistics  and  the  general 
office  force.  At  the  end  of  his  lime  all  stalT  memliers  and  employes  in  the 
health  service  of  the  State  were  on  a  full  time  basis,  functioning  under  a 
splendid  plan  of  organization  which  divided  the  wurk  of  the  Department  into 
ten  divisions. 

When  Dr.  Drake  became  Secretary  of  the  State  IJoard  of  Health  the 
rules  and  regulations  of  the  Board  concerning  quarantine  and  nn)rbidit}-  re- 
ports were  general  and  indefinite  and  the  reports  were  incomplete  and  de- 
lin(|uent.  When  he  gave  up  the  office  of  Director  of  I'nblic  Health  all  the 
rules  and  regulations  had  been  simjilified  and  codihed.  Reporting  ol  dis- 
eases was  reasonably  prompt  and  fairl\-  satislactory  due  in  part  to  the  cddi- 
fication  of  the  rules,  in  part  to  the  free  mailing  privileges  granted  by  federal 
authorities  who  utilized  the  reports  thus  gathered  and  in  part  Id  the  larger 
field  staff  that  stimttlated  better  reporting. 

In  l!ll  I  the  collection  of  vital  statistics  had  fallen  into  a  deplorable  con- 
dition and  there  was  no  satisfactory  law  for  helping  matters  greatly.  Hong 
befiire  l'.i"'l  a  siilendid  law  was  in  effect  and  the  necessary  State  and  local 
machinery  for  collecting  and  compiling  prompt  and  complete  returns  was  in 
existence. 

'I'he  number  of  public  health  nurses  em])loyed  in  the  State  outsiile  Lhi- 
cago  in  1914  was  inconse((uential.  More  than  .'iOO  were  at  work  in  ^'^^l]  and 
a  plan  for  coordinating  their  services  under  the  general  supervision  of  the 
State  Department  of   I'ublic   Health  had  been  agreed  upon  b)-  all  concerned. 

In  r.M-l  the  State  Board  of  Health  operated  a  small  diagnostic  l.aboratory 
in  .'^jiringfield  and  distributed  a  limited  amount  of  biological  products.  At 
the  close  of  l!l'.'(l  there  were  h.alf  a  dozen  bianch  diagnostic  laljoratories  be- 
side the  central  one  in  Springlield  which  had  broadened  out  to  take  on  re- 
search work  and  the  l)iological  products  <lislril)nled  had  increased  cousider- 
abh   in  number  and  volume. 

In  IMll  preventive  medicine  was  little  thought  ol  or  a]i]ireciated  in  the 
])opu!ation  at  large.  By  19"^1  it  had  become  p(rpular  enough  to  leail  news- 
papers, household  ])eriodicals  and  other  |)ublications  to  devott'  much  space 
to  it.  In  Illinois  Dr.  Drake  had  played  a  leading  part  in  popularizing  the 
subject. 


194  i'ri;i.u'  iii-..\i.rii  adm  i  ^■IS■I'RAT10^• 

I  ictw  reii  lull  and  ID'v'l  llic  Slatf  had  discarded  a  ciinilKTSdiiK'  I'oard  of 
Ik'allh  willi  il>  t'lianlic  \va\>  of  |ir(jni(itinL;  public  health  and  in  its  place 
had  imt  a  llcalth  I  )cpai  tnum,  ranking  with  aii\'  mhrr  di-partmiMit  of  the 
Stale  i;(i\eninient.  wilh  a  splendid  organization  plan  for  systematic,  co- 
ordinated, well  balanced  and  up-to-date  service.  The  main  trouble  was  that 
the  "system"  and  "coordination"  were  lacking. 

The  Kawi.incs'  Reoime, 

A  political  change  in  the  administration  of  the  State  government  took 
])lace  in  J.anuary,  l'.)21.  It  l)rought  to  the  Department  of  Public  Health  its 
second  Director,  Dr.  Isaac  D.  Rawlings,  who  took  office  on  February  1. 
Like  most  of  the  executive  officers  of  the  State  health  service  who  had  pre- 
ceded him.  Hr.  K.awlings  hafl  been  with  the  city  health  department  in  Chi- 
cago. Indeed  he  had  s])ent  over  twenty  years  in  the  public  health  service  of 
tha.t  city  and  had  been  closely  associated  with  all  of  the  great  sanitarians  since 
l!i(i()  who  had  built  up  in  Chicago  one  of  the  finest  municipal  health  depart- 
ments in  the  country  and  given  to  the  city  an  envialile  record  for  good  health 
conditions. 

In  education  and  experience.  Dr.  Rawlings  was  better  trained  than  any 
man  who  had  precedeil  him  with  the  possible  exception  of  Dr.  Rauch,  who 
lived,  of  course,  before  the  day  when  preventive  medicine  came  into  its  own. 
Dr.  Rawlings  was  a  graduate  of  Northwestern  University  Medical  School, 
one  of  the  best  in  the  country.  Later  he  spent  considerable  time  at  the  great 
medical  educational  centers  in  Germany,  Austria  and  England.  Then  he 
taught  for  a  number  of  years  in  Northwestern  University  Ale.lical  School 
and  subsequent  1_\-  ])ul  in  twentv  years  at  pulilic  health  work.  He  was,  there- 
fore, thoroughly  familiar  with  the  problems  both  medical  and  sociological, 
the  It-chnical  procedures  and  the  difficulties  to  be  encountered  in  the  field  of 
p)ulilic  health  service. 

.\s  native  e(|uipment.  Dr.  Rawlings  had  a  love  for  routitie  system,  a 
thirst  for  details,  a  passion  for  work  and  a  tenacity  of  purpose  that  led  him 
to  carry  ovu  jilans  and  policies  in  letter  and  sp.irit  alike.  If  the  law  provided 
for  a  board  of  public  health  advis<irs  which  should  meet  (|uarterly  he  wanted 
a  bo.ard  apjiointed  and  he  wanted  it  to  meet  on  the  first  Tuesday  of  ever}' 
third  month  and  he  wanted  it  to  advise,  li  occasion  required  him  to  go  be- 
fore a  legislative  committee  he  was  no  man  to  say  "Mr.  Chairman,  contagion 
is  rampant  in  the  State.  We  need  twice  the  money  we  now  get  to  make 
headway  against  it."  X'o.  lie  had  to  b.ave  with  him  a  ]iicce  of  paper  bear- 
ing official  statistics  and  with  its  help  say  ".Mr.  Chairman,  smallixjx  left  its 
scars  on  S,.');3(i  persons  in  this  State  last  year.  That's  too  much.  It's  costing 
us  close  to  a  million  dollars  a   year.      In   youi'  own   district.   .Mr.   Chairman, 


PUBLIC    HEALTH    ADMINISTRATION  195 

there  were  33.")  cases,  a  ratio  much  lartjer  than  that  for  the  Stale."  To 
satisfy  this  craving  for  system  and  this  desire  for  details  wliich  were  tlie 
tools  of  his  mind  that  brought  out  his  mental  faculties  to  best  advantage  he 
was  willing  to  begin  before  the  sun  rose  and  work  far  into  the  night,  day 
in  and  dav  out.  He  was  determined  that  his  organization  should  put  in 
hiinest  hciurs  and  function  so  that  results  could  lie  reduced  to  tangible  records 
ihat  wiiuld  be  available  at  any  time  for  any  necessary  purpose. 

The  General  Assembly  was  sitting  when  Dr.  Rawlings  assumed  office. 
He  asked  for  an  enabhng  law  that  would  permit  counties  to  employ  trained 
medical  health  officers  to  organize  and  direct  county  health  departments. 
This  the  general  assembly  declined  to  do  but  did  provide  for  25  instead  of 
7  district  health  superintendents  to  work  under  the  State  Department  of 
Public  Health.  Never  before  had  so  large  an  extension  of  the  State  health 
machinery  lieen  arranged  for  by  any  legislature. 

Cixirdiiiatioii  of  Force's. 

.\s  pointed  out  heretofore  there  was  in  existence  v.'hen  Dr.  Rawlings 
arrived  a  splendid  organization  plan  for  the  State  Department  of  Public 
Health.  The  finances  were  budgeted  and  so  were  the  functions.  .\pi)ro- 
priations  were  made  for  specific  purposes  and  personnel,  most  of  which  was 
well  ([u.-ilified  to  perform  the  duties  rec|uired.  was  divided  into  divisions  to 
which  special  types  of  services  were  assigned.  The  main  trouble  was  that 
the  divisions  were  like  so  many  independent  units  functioning  under  a  gen- 
eral head.  Coordination  and  systematization  were  necessary  to  make  the 
Department  produce  maximum  results. 

As  the  first  step  toward  unifying  the  health  machiner)-.  Dr.  Rawlings 
started  the  practice  of  holding  .staft'  meetings  of  division  chiefs  each  week. 
He  laid  before  them  his  policies  and  mapiied  out  his  program.  To  every 
di\ision  was  assigned  the  routine  iirocedures  which  it  was  technically  pre- 
])ared  to  handle  and  such  other  duties  as  it  might  be  able  to  perform  in  con- 
nection with  general  projects  undertaken  by  the  Dejiartment.  This  ])rac- 
tice.  which  still  continues  keeps  all  members  of  the  Department  informed 
abiiin  activities  within  the  1  )ep:irlniem  and  this  greatly  enhances  the  co- 
onlinatiiin  of  elTort.  It  i>  ])articulaiiy  heliiful  In  those  employees  wdio  travel 
about  the  State  and  are  frei|nentl\   iniestinned  about  health  matters. 

B\-  May  K,  P.)21.  Dr.  Rawlings  had  arranged  for  a  meeting  of  all  the 
field  staff,  consisting  of  7  or  S  physicians  with  the  division  chiefs  in  Spring- 
field. That  was  another  step  toward  unification.  Questions  of  policy  were 
discussed,  luich  divi.sion  chief  outlined  the  services  which  he  was  prepared 
to  undertake.  .\ci|uaintances  were  made  for  the  first  time  between  many 
of  those  ])resent.     This  general  conference  of   Dejiartment  members  became 


IDG  I'lnii.ic  iiicAi/rii  admimstkatiox 

an  annual  alTair  and  constitutes  an  ini|"irtani   factor  in  tlic  systematic  oper- 
ation of  the  Stale's  health  machinery- 

A/lrisiiri/  BiKiiil. 

Then  there  was  the  matter  of  an  advisor)-  hoard.  The  Ci\il  Adinin- 
istrati\e  I'ode  provided  for  one,  luade  up  of  live  meinhers.  that  should  meet 
;is  fre<|uently  as  deemed  necessary  hut  not  less  often  than  quarterly.  The 
matter  \\a^  laid  hefore  the  Governor  who  appointed  to  the  board  on  Septem- 
ber •.;■;;,  II''.' I,  the  full  complement  of  members.  It  consisted  of  Dr.  W.  A. 
I'^vans  and  Dr.  John  Hill  Robertson  of  Chicago.  Dr.  E.  P.  Sloan  of  Bloom- 
inSton.  Dr.  C.  W.  l.illie  of  ICasl  St.  Louis  and  Mrs.  l'..  N.  ^Monroe  of  Quincy. 
h'rom  the  outset  the  board  has  met  rcLjularly  and  has  participated  energetic- 
ally in  the  business  of  reiiderini,'  advice  about  tlie  health  policies  and  prob- 
lems of  the  State.  Its  contact  with  the  jirofessional  and  public  life  of  the 
State  enaliled  it  to  not  onl\'  interpret  public  sentiment  but  to  exercise  con- 
siderable influence  o\er  the  trend  of  sentiment  concerning;  health  matters. 
It  has,  therefore,  proved  to  be  an  important  factor  in  welding  together  the 
lualih  niat-biner}'  and  of  guiding  the  activities  of  the  State  Department  of 
I'nlilic  1  le.ilth  along  a  course  that  was  both  sound  scienlihcalh'  and  wise 
sociologicall) . 

Alh  ii///fs  to  Inipnirc  Locul  Ih alfli  MiuIi'iik  iij. 

Local  health  machiner\-  was  another  iniporlant  tactor  in  the  program 
of  unihcation.  The  lars^er  municipalities  had  fairly  well  organize<l  health 
departments  but  the  remainder  of  the  State,  divided  into  some  5.;00  dis- 
tricts, had  for  health  officers  persons  upon  whom  the  law  im])0sed  this  re- 
sponsibility by  \iitue  of  some  other  office  to  which  they  had  Ijeen  elected — 
such  as  coimt\-  sU])ervisor,  assessor,  town  clerk-,  village  president,  etc.  Not 
only  were  these  men  untrained  in  public  health  work,  generally  s]ieakin,g,  but 
they  fre(|uenlly  ch.mged  with  local  elections  and  the  State  Director  of  Health 
had  no  means  of  knowing  about  it. 

Dr.  Kawlinns  w  ,is  ambitious  to  substitute  the  count\  for  tlie  township 
as  the  unit  for  local  he.ilth  organization  and  to  create  a  deiuaml  for  well 
trained  niedie.il  he.ilih  officers.  The  ( leneral  Assembly  turned  down  an 
en;ibliiig  hill  in  IH'JI.  .Xevertheless  Dr.  Kawlings  jnished  forward  his  plans. 
I'i\-  the  end  of  lie.' I  1,^  had  created  sentiment  favorable  to  a  count\-  health 
service  in  .Morgan  t.'ouiity.  With  some  lin;incial  helji  from  the  International 
Health  lio.ird  and  some  from  the  Si.ite,  .Morg.m  C'ount\'  inaugurated  the  first 
full  time  connt\'  he,-dlh  service  in  Illinois  in  the  spring  of  1'.I32.  This  Dr. 
Rawlings  pl.inned  to  use  as  a  deiuonslralion  project  both  to  other  counties 
and  to  the  (  leneral  .\sseml>l\'.  It  h.as  pleased  Morg;m  C'ounl\  well  enough 
to  be  continued  on  ,i  |)ermanent   basis. 


MEMBERS 

First  Boaud  of  Public  Health  Advisors 

cpj^oinied    S'epicml'cr  'ZQ.  /P2/. 


E.  P.  Sloaii,m.D. 


-T^t 


V">A.EvaJis.9IL.D. 

Chaio/Ut/i 


;^f^ 


^^^.. 


\amV.miiM.D.*  \ 

Sccce.ta.ry 

*"•"!       *Dt'.EAS'-D I ' 


JoHiiDilltolwtson.lIl.D. 


198  I'UP.LIC    IIICAI.Tli    ADMIXlSTRATinx 

An  enabling  bill  authorizing  counties  to  establish  health  <le[)artment3 
failed  again  to  pass  the  General  Assembly  in  1923  but  a  bill  re(|uiring  county 
clerks  to  rejwrt  annually  to  the  State  Department  of  l\iljlic  llcalih  the  names 
anil  addresses  of  all  local  officials  concerned  with  public  health  duties  did 
become  law.  This  linked  up  the  ne])artnient  more  closely  with  local  com- 
munities than  any  other  one  thing  since  the  law  creating  local  health  ofticers 
was  enacted. 

In  I'lVI  another  attcni])t  was  niade  to  stimulate  the  development  of 
county  health  departments.  This  time  arrangements  were  made  with  the 
United  States  Public  Health  Service  and  the  International  1  lealth  Board  to 
help  finance  a  certain  number  of  units  and  Dr.  Thomas  Parran.  Jr.,  sur- 
geon on  the  staff  of  the  Utiiled  States  Public  Health  Service,  who  had  had 
a  wide  experience  in  the  development  of  rural  health  service,  was  detailed 
to  work  in  Illinois  under  the  State  Department  of  Public  Health.  Dr.  Par- 
ran  started  to  work'  in  June  and  bv  Juh-  1,  Crawford  County  had  emjiloyed 
a  full  titne  health  officer  and  organized  a  de])artment.  ."Shortly  afterwards 
Wabash  Coutit\'  decided  to  do  the  same  but  difficulties  arose  over  local  au- 
thority to  appropriate  funds  so  that  the  plans  didn't  materialize.  The  de- 
partment in  Crawford  was  short  lived.  The  attorney  general  c;f  the  State 
expressed  the  opinion  that  counties  could  spend  money  for  the  control  of 
diseases  in  the  face  of  epidemics  but  that  they  were  unauthorized  to  do  so  for 
preventive  activities  when  contagious  infections  were  not  present.  This 
opinion  settled  the  matter.  -\n  enaf)ling  law  was  necessary  before  j^rogress 
could  be  made  in  building  U])  count\'  health  departments.  So  far  no  such 
law   has  been  enacted. 

.\  full  time  rural  health  service  was  established  in  Cook  County  in  1924 
and  one  in  DuPage  in  192.J  as  a  result  of  efforts  of  the  Department.  Both 
have  continued  to  date  and  appear  to  be  ])ermanent. 

Dr.  Kawlings  now  gave  his  attention  to  the  improvement  of  municipal 
health  service  in  the  State.  Under  Dr.  I^arran  a  surve)'  of  the  1.")  cities 
ranging  between  oO.OOO  and  PIO.DOO  population  was  undertaken.  It  was 
certainly  a  different  project  from  the  Ranch  survey  just  l(t  years  before. 
The  Ranch  survey  considered  alleys,  back  vards,  cellars — cnvironmeiU.  The 
Rawlings'  surve_\-  measured  the  character  of  health  service  by  the  results 
ol)lained.  It  is  interesiiuL;  to  note  th.at  both  were  patterned  after  the  teach- 
ing of  the  American   Public  Health  .\s>ociation  in  their  time. 

.\s  a  means  of  creating  interest  in  local  health  .'idministration.  the 
Kawlings'  surxey  wa^  the  most  successful  single  acti\it\-  the  State  Depart- 
ment of  Pitblic  Health  t-ver  undertook.  Pach  city  was  rated  on  a  percentage 
iiasis  as  ;i  result  of  the  fnidings  and  the  newspapers  devoured  the  reports. 
National  magazines  interested  in   the   pnl)lic  health   lield  coiumented  exten- 


PUBLIC    HEALTH    ADM  I  XISTRATIOX 


lOil 


sively  on  it.  More  important  still,  the  cities  concerned  took  steps  to  make 
the  improvements  recommended.  Evanston,  for  example,  replaced  a  part 
time  with  a  fnll  time  health  officer.  Other  of  the  cities  built  isolation  hos- 
pitals. ])ut  on  public  nursing  services,  started  infant  welfare  projects  and 
added  such  other  improvements  as  seemed  practicable  imder  local  circum- 
stances. 

In  January.  TJ"24  a  system  of  clinics  which  the  State  Department  of 
Public  Health  had  been  conducting  for  a  number  of  years  for  the  benefit 
of  crijipled  children  was  discontinued.     These  clinics  involved  a  consider- 


OR&AniZATIOn    OF 

5TATE  DEPARTHEnT  OF  PUBLIC  HEALTH 

1927 


GBIERAL  OmCE 


57ATI  OF  ILLinOIS 
DEWRTrtm"  OF  PUBLIC  HEALTh 

Director  of  Public   Mealth 
A55i5tant  Director 


mxns  Of  LABoiiAiaxs 


iL- 


.|f=°^^ 


Ilk. 


L. 


Fig.  11.    Showing  the  available  strensth  of  the  State  Department  of  Public 
Health  on  July  1.  1!I27. 

able  amount  of  curative  or  correctixe  practice  and  this  had  caused  some 
unfavorable  feeling  in  the  ranks  of  the  medical  profession.  The  work  was 
continued  under  the  atispices  of  vdlnut.nry  agencies  but  its  divorcement  from 
the  State  service  left  the  lleallh  Dcparuiicnt  free  to  engage  in  purely  pre- 
ventive activities. 

MdtcniH  1/  and  Cluhl  lli/fiiciic. 

To  stimulate  activitv  in  the   field  of  niatcrnit\-  and  chikl  hygiene.   Dr. 
Rawlings   took   advantage   of   the   fmancial    ^upiiurt   offered   by   the    federal 


200  ri'iii.n    111-;. \i. Til  ahm  ixisi  ration- 

government  thi(iiiL;li  llu-  children's  hurcau  under  what  is  ordinarily  called 
the  Sheppard- I  uwiKT  Act.  A  (h-;ift  (ni  the  federal  treasury  in  favor  of  the 
State  of  Illinois  to  the  amount  of  over  $1!),000  was  forwarded  to  Dr. 
Rawlings  during  the  summer  of  1922  but  the  State  auditor  had  no  legal 
authority  to  accept  the  funds  and  the  legislature  declined  to  ever  grant 
that  authority.  Thus  the  State's  child  hygiene  program  had  to  he  worked 
out   with  no  outside  tuianctal  snp|i(irt. 

This  was  undertaken  by  the  furniation  in  li)25  of  a  State  advisory  com- 
mittee on  child  hyt;iene.  (  )n  it  are  represented  the  Illinois  State  Medical 
Society,  tile  Illinois  State  Dental  Society,  the  Illinois  Federation  of  Women's 
Clubs,  the  Illinois  Council  of  I ';irent-Teacher  Associations  and  the  State 
Department  of  Public  Health.  Through  this  committee,  which  has  before 
it  plans  and  programs  concerning  maternity  and  child  health,  a  considerable 
amount  of  strengfth  has  been  added  to  the  State  health  machinery.  It  func- 
tions by  informing  the  several  ori;anizations  concerned  about  the  programs 
and  special  campaigns  undertaken  by  the  State  health  officials  and  exercises 
no  small  inlluence  in  putting  oxer  definite  projects.  Thrc'ugh  it,  for  instance, 
direct  contact  was  made  with  club  women  and  parent-teacher  associations 
in  every  countv  of  the  State  in  connection  with  a  diphtheria  eradication  cam- 
])aigii  in   llt2(i. 

Another  link  in  the  chain  that  systematized  health  work  in  the  ."-^tate 
was  welded  wlu'ii  Dr.  Rawlings  succeeded  in  interesting  the  Uliiniis  State 
Dental  Society  in  a  mouth  hygiene  program.  The  Illinois  Stale  and  Chicago 
Dental  Societies  agreed  to  pay  the  salary  of  a  dentist  to  work  uiuler  the 
State  Department  of  Public  Health  as  a  temporarv  demonstration  of  what 
could  be  dene.  The  Illinois  Tuberculosis  .\ssociation  contributed  some  funds 
to  this  ])roject.  The  plan  was  carried  out  beginning  in  August.  192(i.  It 
culminated  on  Julv  1.  lli"3;  when  appropriations  made  by  the  li)2T  General 
.Assembly  became  available   for  continuing  the  |irogram. 

Ollirr  Activities. 

In  l!)2.j  arrangements  were  made  to  open  a  branch  diagnostic  lalxn'atory 
in  C  arbdiidale  and  in  \'J'>',  amither  was  opened  in  Chicago.  Prior  to  these 
dates  branch  l.al.oraldries  had  been  establislied  and  maintained  at  various 
points  but  their  wcnk  was  conlined  to  diplitheri;i.  These  two  new  branches 
were  e(|uip|)ed  ti>  handle  pr;iclically  exery  l^in(l  of  procedure  common  in  pub- 
lic health  L-ilmratiiries.  This  step  provided  dia,i;ni'stic  laboratory  facilities 
in  easy  reach  nI  every  part  of  the  .^tate  so  tli.it  physicians  and  the  public 
could  profit  by  prom])t  service  whenever  nee<le(l. 


PUBLIC    HEALTH    ADMINISTRATION  201 

rifdl  Stiltisfirs. 

When  Dr.  Rawlings  was  apimintcd  State  director  of  Public  Health  in 
lii-'l  the  most  obvioits  shorten  niing-  of  the  Department  concerned  statis- 
tics. ISirth  registration  was  'iO  jjer  cent  deficient  and  accordingly  was  not 
recognized  l)y  the  federal  bureau  of  the  census.  To  get  Illinois  into  the 
United  States  Ijirth  registration  area  was  the  first  extra-routine  task  that 
Dr.  Kawlings  undertook. 

lie  went  about  the  matter  melluKlicall)-.  The  subject  was  thoroughlv 
aire<l  at  staff  meetings.  A  communication  requesting  cooperation  and  citing 
the  birth  registration  law  was  directed  to  every  practicing  physician  in  the 
State.  The  1,K)0  odd  local  registrars  were  advised  of  their  duties  and  re- 
sponsibilities. Birth  records  in  the  office  of  the  State  registrar  were  analyzed 
so  that  the  amount  of  delinquency  in  every  county  and  in  all  the  larger  mu- 
nicipalities was  closely  estimated.  The  Illinois  Federation  of  Women's  Clubs 
was  prevailed  u])on  to  partici])ate  in  the  campaign  by  appointing  local  club 
women  all  nver  the  .State  to  make  birth  registration  surveys.  .\11  the  field 
personnel  nf  the  Department  from  whatever  division  were  informed  of 
registration  (lelin(|uencies  so  that  each  could  \isit  doctors  and  registrars 
in  his  district  or  along  his  itinerary.  Local  state's  attorneys  were  called 
upon  freely  to  handle  the  few  legal  cases  that  appeared  unavoidable  with 
recalcitrant  offenders,  ^\'ithin  eighteen  nKJiiths  birth  registration  was  so 
nearly  complete  and  returns  were  so  prompt  that  Illinois  was  admitted  tii  the 
United  -States  birth  registration  area  and  the  lil-J'.'  statistics  accepted  by  the 
federal  Ijureau  of  the  census  for  that  purpose. 

The  chief  significance  of  the  birth  registration  campaign  was  its  effect 
on  the  State  health  machinery.  It  had  knit  together  the  various  divisions 
of  the  Department  in  a  common  purpose  above  that  encountered  in  ordinary 
routine.  It  had  brought  into  acticn  a  great  potential  strength  for  doing 
local  health  work  and  influencing  public  opinion — the  women's  clubs.  It  had 
aw-akened  a  li\ely  interest  among  physicians.  It  had  introduced  the  official 
legal  talent  of  local  comnnmities  to  the  laws  governing  public  health  service. 

I'.ut  birili  registration  was  only  one  of  the  statistical  problems  that 
faced  1  )i'.  Raw  lings.  No  detailed  mortality  rates  had  e\'ei  been  computed 
in  the  .State  for  official  publication.  Figures  that  were  availalile  had  been 
compiled  on  a  fiscal  year  basis  so  that  they  were  incomparable  with  those 
of  other  states.  This  situation  was  remedied  when  Dr.  Rawdings  introduced 
into  the  Department  a  system  if  nionihlv  and  semi-annual  reports  from 
divisions  and  insisted  on  having  the  annual  report  when  it  was  due.  Bv 
the  end  of  his  first  year  in  office  Dr.  l\awlings  had  succeeded  in  getting 
for  publication  a  detailed  infant  mortality  statement  covering  every  county 
and  every  principal  city  in  the  State,  the  first  report  of  the  kind  ever  issued 


202  PUm.ll'    IllCAI.l'll    ADMINISTRATION" 

by  the  Deijartnient.  IJy  tin-  middle  of  \'J-12  nicirtalily  tables  showing  the 
cause  of  each  death  in  the  Slate,  ptierjieral  <le,Tths  by  counties  and  cities 
and  detailed  infant  mortality  fates  for  IK'.'I  were  available.  This  progress 
was  continued  fri)m  year  to  year,  time  limits  being  set  for  the  delivering 
of  similar  reports,  until  19".^^  linds  taliulatioiis  and  analyses  of  the  State's 
mortality  records  in  practicall\-  all  standard  forms. 

Comnumicahle  disease  re])ort.'  likewise  needed  much  improxement. 
They  were  incomplete  on  the  one  hand  and  not  easily  availalile  for  utiliza- 
tion on  the  other.  Dr.  Rawhngs  iiUroduced  a  system  of  daily  reports  from 
the  division  chiefs  to  his  own  office.  Then  he  put  into  eft'ect  a  system  of 
cross  checking  between  iiKirtality  records  and  case  reports.  Furthermore 
he  had  brought  together  into  one  tabulation  the  cases  and  deaths  from  the 
principal  reportable  diseases  for  every  county  and  city  of  lO.lXK)  or  more 
in  the  State.  Then  he  began  the  practice  of  sending  a  field  physician  to 
investigate  every  reported  case  of  smallpox,  typhoid  fever  and  chickenpox 
in  adults.  These  procedures  revealed  the  weak  spots  of  notification  and 
led  not  only  to  a  distinct  improvement  in  the  completeness  and  promptness 
of  reports  from  the  field  but  also  to  the  utilization  of  the  data  collected. 
To  operate  the  system  inaugurated  records  had  to  be  kept  m  good  shape 
and  that  is  just  what  happened.  By  every  available  test  it  appears  that 
communicable  diseases  are  reported  now  (l!)".^';)  in  Illinois  as  satisfactorily 
as  the)'  are  anywhere  in  the  country. 

Safe  Mill:  Stipplirs. 

The  ])roblem  of  safe  mill<  furnishes  another  illustration  of  the  system 
which  Dr.  Rawlings  introduced  into  the  operation  of  State  health  machinery. 
Sanitarians  everywliere  recognize  the  safety  of  milk  supplies  as  scarcely 
second  tcj  safe  water  supplies  in  importance  to  general  health  conditions. 
With  the  exception  of  tuberculin  testing,  little  had  been  done  to  promote 
the  .safety  of  mil'iv  outside  of  Chicago  in  Illinois  prior  to  \'J2\.  In  that 
year  the  ."^tate  Department  of  Public  Health  set  to  work  on  the  problem. 
Dr.  Rawlings  apjiointed  a  committee  representing  several  <li\isions  to  stud} 
the  i|iie^ti(in.  After  cimsulting  with  experts  in  the  Department  cf  .\gricul- 
ture  and  at  the  L'nivcrsit\-  of  Illinois  the  committee  drew  up  an  orcHnance 
suitable  fur  ado]>lion  1j\'  munici]jalities.  In  .\ugust  \'.)2'2  the  ordinance 
was  brimght  before  and  thoroughlv  discussed  by  a  group  of  the  most  repre- 
sentative .sanitarians  and  milk  dealers  of  the  State,  gathered  in  Chicago  at 
the  Pageant  of  I'rdgress  In  ccmsider  imjiortant  public  health  problems,  and 
received  a  vote  of  ajiprcxal  by  thai  body.  The  ordinance  was  evidently 
about  right. 


MEMBERS 

Present  Board  of  Public  Healtli  Advisors 


{i    ■'^■ 


€ 


W?  A.Evaivs/l.D. 


Via  -  C/iMr/rutK 


Tlws.D.I'oaa.t.D. 

Chairman 


E.  P.  Sloaa.l.P. 


Hecniii]i''Lliatuksf,ti,t,l). 

Seccettif^ 


204  iTiiijc  iii:.\i/rii  adm  ixisiratiox 

'J'he  next  step  was  to  get  the  ordinance  adopted  by  local  immicii)alities. 
'iliis  task  was  approached  in  the  same  way  that  proved  successful  in  birth 
registration.  Communications  went  out  to  mayors.  Traveling  representa- 
tives of  the  Department  from  whatever  division  who  had  opportunity  to 
promote  the  idea  were  given  assignments  to  meet  with  local  officials,  leaders, 
civic  organizations  etc.  By  1927  a  total  of  (iO  cities  with  a  combined  popula- 
tion (if  cSJJO.OoO  had  adopted  the  ordinance. 

P>ut  adopting  an  ordinance  wotild  not  in  itself  provide  safe  milk.  It 
had  provoked  thought,  however,  and  soon  the  Department  began  to  get 
requests  for  information  abtiut  various  municipal  supplies.  This  led  to 
a  survey  of  all  milk  pasteurizing  ])lants  in  the  State  by  the  division  of 
sanitary  engineering.  The  First  survey  was  made  in  1921  before  much  agi- 
tation for  improvement  had  begun.  Then  in  1924  a  sanitary  engineer  was 
assigned  to  do  nothing  but  milk  work.  In  1925  a  law  that  required  the  cer- 
tification li\-  ihc  ."^tate  I'eiiariment  of  Public  Health  of  all  plants  pasteuriz- 
ing milk  was  passed.  .\t  the  same  time  pro\'ision  was  made  for  em])loying 
a  milk  sanitarian  and  a  milk  bacteriologist  and  the  pmxhase  of  a  mobile 
laboratoi\-  to  be  used  in  that  work.  Thus  bv  I!i2;  the  De])artment  of  Health 
had  ciinsiderabh'  broadened  its  safe  milk  program  and  was  m  a  position 
to  jirosecute  the   undertaking  in   earnest. 

This  milk  project  brought  the  State  health  machinery  to  ojierate  syste- 
maticalh"  in  a  lield  thai  had  lieen  entered  before  onlv  spi  radicallv  and  in  a 
haphazard  kind  of  way.  It  lirnught  milk  deak-rs  and  producers  into  contact 
with  health  work  more  delinitely  than  they  had  before  experienced.  Under 
Dr.  Rawlings  milk  dealers  became  acti\e  agents  of  the  State  Department 
of  Public  Health  because  it  would  In-  an  unwise  business  man  indeed  who 
could  ignore  a  bad  report  on  his  milk  pasteurizing  plant  and  especially  so 
when  he  was  informed  that  responsiliilit\'  fur  e|ii(lemic  outbreaks  that  might 
be  traced  to  his  products  would  be  put  >(|uarel\    up  to  him. 

jlpitrccidtiiiii   (if   Di'jiinl nil  lit (il  Jin/iilat miis. 

In  192"i,  following  the  development  of  a  rather  unusual  incidence  of 
tvphoid  fewr  attributed  to  contaminated  oysters,  an  order  was  issued  by 
])r.  Rawlings  jirohibiting  the  sale  of  oysters  in  the  State  for  raw  consump- 
tion. The  effect  of  the  order  was  nation-wnde  in  magnitude  and  disastrous 
for  the  ovster  industry  (  )nc  conference  between  representatixes  of  the 
oyster  in<histr\'  and  |>nlilic  health  officials  followed  fast  upon  the  heels 
of  another.  With  the  Illinois  Director  of  k'nlilic  Health  as  the  central 
figure  the  affair  soon  eame  to  the  attention  of  the  United  States  Public 
Health  Service  and  nearly  e\ery  state  health  olVicer  in  the  country.  The 
result  was  a  general  sanitary  iniiiros  enienl  in  the  production  and  distribution 


PUBLIC    HEALTH    ADM  I  X  LSTRATION  205 

of  shell  fish,  made  necessar)-  to  meet  requirements  laid  down  by  Dr.  Raw- 
lings  and  the  Illinois  Oyster  Committee  for  any  oysters  allowed  on  the 
markets  of  Illinois.  Indeed  a  couperative  slate  and  national  system  of 
certifying  oyster  jjroducing  concerns  was  created  and  continues  to  operate 
under  the  general  supervision  of  the  United  States  Public  Health  Service. 

This  oyster  business  represented  a  new  use  of  the  authority  granted  to 
the  State  Department  of  Public  1  lealth  t(i  make  rules  and  regulations  con- 
cerning health  matters.  Bv  such  action  the  .^tatc  health  machinery  extended 
its  influence  from  coast  to  coast,  causing  a  general  sanitary  adsancement  in 
a  great  industrial  field. 

Again  in  19"36  use  was  made  of  the  same  type  of  authority.  This 
time  the  action  related  to  stearate  of  zinc  toilet  powder.  A  few  deaths  of 
infants  had  been  attributed  to  the  accidental  inhaling  nf  this  kind  of  pow  tier. 
All  cases,  it  appeared,  could  have  been  prevented  had  the  powder  containers 
been  e(|uipped  with  automatic  safety  caps.  Accordingly  it  seemed  wise  to 
prohibit  in  Illinois  the  sale  of  stearate  of  zinc  toilet  j)Owder  except  in  safety 
containers.  This  was  done  and  again  the  effect  was  nation-wide  because 
the  large  manufacturers,  engaged  as  thev  were  in  inter-state  commerce, 
[preferred  to  turn  out  a  uniform  product  to  ,ill  of  their  trade,  including 
Illinois.  Thus  again  was  demonstrated  the  f.ir  reaching  influence  i.if  the 
power  of  the  ."-^tate  l)ei)artment  of  Public  Hcaltb  to  make  rules  and  regula- 
tions. 

Ediicdlioiial  and  Mu^cclluiicoiis  Aitu'ltics. 

Another  activity  that  strengthened  and  extended  the  influence  of  the 
State's  health  machinery  related  to  health  education.  In  l!)2.j  arrangements 
were  made  between  the  State  Department  of  Public  Health,  the  .^tate  De- 
partment of  Registration  and  Education  .and  the  five  State  Normal  schools 
to  introduce  courses  of  health  instruction  in  the  curricula  of  the  institutions. 
The  object  of  these  courses,  which  ha\e  been  introduced  and  expanded  as 
rapidly  as  facilities  permit,  is  to  provide  prospective  teachers  with  the  sort 
of  sanitary  and  hygienic  knowledge  necessary  for  their  personal  health  bene- 
fit and  to  ecjuip  them  to  not  only  impart  knowledge  to  children  but  to  exer- 
cise intelligent  supervision  over  their  health  in  the  school  room.  This  links 
up  a  great  educational  system  with  the  State's  health  machinery  and  plants 
the  seed  of  sanitary  knowledge  where  \\u-\  ai'e  apt  to  \ield  the  greatest 
returns. 

The  foregoing  references  to  projects  imdertaken  by  the  State  Depart- 
ment of  Public  Health  under  Dr.  Rawlings  by  no  means  exhaust  the  field 
of  activities  which  might  be  drawn  upon  but  they  are  sufficient  to  illustrate 
very  well  the  process  of  welding  together  the  resources  of  the  State  for  doing 


200 


PUHLIC    IIICAI.TH    ADMINISTRATION 


public  health  wdik  uhii-h  has  characterized  his  entire  administration.  In 
every  divisiim  the  vdhimc  of  work  done  has  expanded  very  noticeably.  On 
all  sides  a  greater  degree  of  codrdination  than  had  hithertu  existed  has 
prevailed. 

\'ery  few  ciianrjes  in  the  organization  plan  were  made  by  Dr.  Rawlings. 
During  his  lirst  year  he  eliminated  the  division  of  surveys  and  rural  sani- 
tation, transferring  the  work  and  personnel  to  the  division  of  sanitary 
engineering.  Otherwise  the  divisional  arrangement  was  unmolested.  Each 
division  grew  in  size  and  enlarged  its  volume  of  work  but  '■emained  in  the 
organization  scheme  as  thev  were  under  the  organization  plan  which  ])re- 
vailed  when  Dr.  Rawlings  liecanie  State  Director  of  Public  Health. 


\ 


^StaTEDept'^vPublicHealth' 


..  ..'.I      r.':NTflL  ADVICE        ■  !-•■ 


A  line  o(  25  to  100  deep  constantly  flanked  the  entrance  to  the  adult 
examination  booths  at  the  1925  State  Fair. 


^l  /ijiid/iruit  ion. 

'I'lie  last  ap|)rnpriati(in  made  to  the  State  Department  of  Public  Health 
prior  to  tin-  ap|iiiiitnu  lU  (if  Di'.  Rawlings,  that  made  b\-  the  (ieneral  Assem- 
bly in  I'.tP).  amiiuntt'd  to  $120,810  for  the  bicimiuni.  In  I'.tvll  the  biennial 
appropriaiiiin  jumped  to  -$1, 119, 7  12.  After  that  it  changed  but  little  up  to 
the  pre-ent  lime  .\ugust  1!12:.  it  fell  liack  to  $!)85,o8?  in  1!)23,  due  to 
;iiui-adminisiratiiin  pdliiical  nianiu\ers  but  1II2.J  found  the  grant  back  u])  to 
$1,138,88;.  In  1!)2;  ihe  ( ieneral  Assembly  voted  $1,187, 684  for  the  gen- 
eral expenses  of  tlie  .^tate  De])artment  of  Public  Health  during  the  ensuing 
twd  fiscal  vcars.  This  is  a  substantial  incri-ase  of  money  compared  w-ith 
the  modest  sum  of  -t.'i.ooo  approjiriated  fifty  years  before  to  carry  the  infant 


rUBLIC    HEALTH    ADM  I  X  ISTKATION 


20? 


State  Board  of  Health*  along  through  its  first  two  years  of  life.  Com])ared 
with  funds  provided  by  many  other  states,  including  Xew  ^'ork,  Pennsyl- 
vania and  Massachusetts,  for  public  health  purposes  the  amount  appro- 
priated by  Illinois  in  1!)2T  is  relativel\'  small  as  she  ranks  twentieth  among 
the  States  in  her  jier  ca])ita  expenditure  for  health  although  she  is  tliird  in 
wealth  and  population. 

The  organization  of  the  State  Department  of  Public  Health  in  1!)2T  is 
graphically  shown  bv  the  illustration  in  Fig.  11.  How  this  differs  from  the 
organization  in  1i)lT.  the  first  year  under  the  Civil  Administrative  Code,  in 


AnnUAL    APPROPRIATIONS 


1879-1927 

fAPPROPRiATIOnS    MADE    BIEnniALLY) 


F:g.  12. 


IIM.").  the  last  year  under  the  State  Board  of  Health  and  in  is;:,  the  first 
year  under  the  State  Board  of  Health  mav  l.)e  observed  bv  reference  to  Figs. 
8,  9,  and  10. 

H  iiuniKini. 

When  Dr.  Rawlings  became  State  Director  of  Pub'ic  Health  in  1!I2  1 
he  found  the  Department  functioning  under  a  well  devised  organization  plan 
with   facilities   for  ])articipating  in  practically  every  phase  of  public  health 


208  ruiu.ic  iii:ai.tii  ahm  i  n  isi  i.:Ari().\ 

stTvict  liUt  it  was  Idciscly  linuiid  together.  At  the  time  this  is  written  in  V.)27 , 
wiiii  Dr.  i\,i\\  lings  still  in  oi^ce,  the  variuns  divisions  are  coordinated  intu 
a  nnilicd  Department  which  is  capable  of  moving  swiftly  and  efficiently  to- 
ward the  at  liievenKiit  nl'  any  general  purpose  and  at  the  same  time  each  di- 
vision takes  care  of  the  routine  ]irohlems  within  its  own  i)articular  field  with 
all  other  divisions  fully  informed  of  the  work  being  done. 

When  Dr.  Kawlings  assumed  office  most  of  the  divisions  in  the  De- 
[lartnieni  w  ere  \eiy  small  and  several  of  them  were  scarcely  more  than  skele- 
ton units.  By  !!:»•<;?  all  of  them  had  been  materially  strengthened,  giving 
the  Department  the  capacity  td  perform  jiromptly  and  elYectively  all  of  the 
activities  in  which  it  professes  to  engage. 

The  foregoing  statements  concerning  the  health  machinerv  in  the  State 
suggest  the  way  emjiloyed  by  Dr.  Rawlings  in  binding  it  together  into  a 
systematic  whole  so  that  every  unit  of  the  State  Department  of  Public  Health 
and  every  other  agency  engaged  on  a  significant  scale  in  public  health  work 
meshed  together  in  their  programs  and  eft'orts  like  gear  wheels  that  drive 
mechanical  machines,  b'vidence  that  the  job  was  well  done  is  found  in  the 
accuracy,  magnitude  and  [iromptness  of  returns  of  statistical  data  dealing 
with  births,  deaths  and  disease.  Another  evidence  is  found  in  reports  of 
local  participation  in  various  campaigns  inaugurated  by  the  Department.  A 
still  more  important  evidence  is  the  freedom  which  the  State  has  enjoyed 
from  epidemic  diseases  and  the  steady  decline  in  infant  mortality  and  the 
prevalence  of  such  diseases  as  smallpox,  typhoid  fever  and  diphtheria. 

Much  detailed  information  concerning  the  organization,  functions  and 
activities  of  the  various  divisions  may  be  found  in  the  chapter  on  each  di- 
vision's history. 

Intra-Departmental  Organization  of  State  Health  Machinery 

b'roni  the  time  when  the  State  Board  of  Health  was  cre.'ited  until  IS'.M) 
there  was  no  distinct  division  of  labor  among  the  regularly  employed  per- 
sonnel. In  julv  of  that  year  two  men  were  appointed  to  devote  their  full 
time  to  the  inspection  of  lodging  houses.  While  these  appointments  were 
originally  made  on  a  temporary  basis  they  proved  to  be  permanent  in  char- 
acter and  became  established  as  a  distinct  unit  of  the  State  health  machinery 
when  the  General  Assembly  made  a  specific  appropriation  for  lodging  house 
inspection  in  1:m)1.  This  then  was  the  first  step  toward  a  .State  health  ser- 
vice organized  into  specialized  units. 

.Along  about  1902  or  1903  one  member  of  the  office  staff  of  the  State 
Board  of  Health  was  designated  as  State  registrar  of  vital  statistics  but  in 
1904  the  same  man.  W.  !I.  Hoyt,  was  also  designated  as  State  bacteriologist 
and  given  charge  of  the  small  diagnostic  laboratory  which  started  then.    Then 


rUBLIC    HEALTH    All-MIXISTKATION  209 

ill  VJO'j  the  General  Assembly  included  "registrar  of  vital  statistics",  "bac- 
teriologist" and  "laboratory"  as  items  for  whicb  specific  appropriations  were 
made.  Yet  it  appears  that  no  marked  division  of  labor  took  place  but  that 
the  technical  and  clerical  employes  were  subject  to  routine  duties  of  what- 
ever character  might  be  most  pressing  at  the  moment. 

Subsequent  to  1905  there  appears  to  have  been  little  or  no  attempt  at 
organizing  the  resources  of  the  State  Board  of  Health  into  specialized  units 
until  1915  when  a  definite  plan  of  organization  was  adopted  and  five  bureaus 
were  created.  These  included  "medical  and  sanitary  inspection",  "vital  sta- 
tistics", "laboratory",  "sanitary  engineering"  and  "lodging  house  insjjection". 
Each  of  these  was  the  forerunner  of  what  became  a  division  of  the  State 
Department  of  I'ublic  Health  under  the  Civil  Administrative  Code  adopted 
in  191  T. 

The  first  appropriation  under  the  Civil  Administrative  Code,  made  in 
1917,  specifically,  provided  for  seven  divisions.  These  included  "general 
office",  "communicable  diseases",  "tuberculosis",  "sanitation",  "diagnostic 
laboratory",  "\ital  statistics"  and  "lodging  house  inspections".  As  a  matter 
of  fact  1(1  divisions  were  created  in  \'M].  including  besides  those  listed  above 
"child  hygiene  and  public  health  nursing",  "surveys  and  rural  hygiene"  and 
"public  health  instruction".  To  these  was  added  the  division  of  "social 
hygiene"  in  1918.  In  1927  the  divisional  designation  was  the  same  except 
that  the  division  of  "surveys  and  rural  hygiene"  had  lost  its  identity  in  1921 
and  the  division  of  sanitation  changed  its  name  to  "sanitary  engineering". 
Details  concerning  each  division  are  enumerated  under  its  own  title  on  the 
following  pages : 

Gener.\l  Office. 

The  general  office  is  made  up  of  the  Director,  assistant  director,  chief 
clerk  and  corps  of  clerks.  Up  until  19i;  the  general  office  was  about  synon- 
ymous with  the  State  Board  of  Health  so  far  as  sanitary  and  hygienic  work 
was  concerned.  Sanitary  engineering,  diagnostic  laboratory  services  and 
field  medical  activities  were  centralized  under  different  heads  and  the  first 
two  occupied  independent  quarters.  There  was  also  a  registrar  of  vital  sta- 
tistics but  this  work  was  done  in  the  main  office  and  came  under  the  imme- 
diate supervision  of  the  chief  clerk  of  the  State  Board  of  Health. 

Since  1895  the  general  office  has  been  presided  over  by  a  chief  clerk 
Prior  to  the  introduction  of  the  division  plan  the  chief  clerk  actually  directed 
the  office  personnel  employed  in  the  State  health  service  with  the  exceptions 
mentioned,  .\fter  the  introduction  of  the  division  .system  in  1917  the  gen- 
eral office  has  been  a  headquarters  unit  through  which  divisional  contact  is 
maintained.  Technical  matters  are  left  entirely  to  the  division  chiefs  who 
are  responsible  to  the  director  for  matters  of  a  scientific  and  technical  nature. 


211) 


'UBLIC    IM'.AI.TII    ADM  IMS'IUATION 


Mr.    Chas.    Ry 


All  department  records  and  correspondence  are  hanilled  by  the  general 
office.  Through  it  all  accounts  are  settled  including  payrolls.  In  it  is  lo- 
cated the  central  filing  system  which  was  introduced  by  Dr.  Rawlings  in 
192G.     All  personnel  records  are  also  ke])t  there. 

Although  it  was  customary  to  have  one  person  in 
charge  of  the  clerical  force  prior  to  that  time,  specific 
provision  for  a  chief  clerk  was  first  made  by  the  legis- 
lature in  18!).").  Mr.  F.  A.  Treacy  was  the  first  man 
a])pointed  to  hold  that  position,  he  being  already  in  the 
employ  of  the  State  Board  of  Health,  at  the  time  the 
jsition  was  first  recognized  by  the  legislature  in  the 
appropriation  law.  He  was  succeeded  in  May,  ISDT, 
Mr.  Charles  Ryan  who  in  turn  was  succeeded  on 
Mav  I,  1 !)()!,  bv  Mr.  Amos  Sawyer.  Mr.  Sawyer  has 
filled  the  office  of  chief  clerk  cimtinunu^ly  from  the 
time  of  his  appointment  to  date. 

Divi.sioN  OF  Communicable  Diseases. 

The  work  of  this  division,  as  the  name  implies,  is  concerned  directly 
with  the  control  of  contagious  and  infectious  diseases.     It  has   charge   of 
morbidity   reports,   quarantine,    rules   and   regulations    relating   to    reporting 
and  quarantine,  epidemiological  investigations, 
promotion  of  local  health  machinery  and  the 
distribution  of  biologies  such  as  antitoxin,  vac- 
cine, silx-er  nitrate,  etc. 

While  activities  of  the  character  of  those 
performed  by  llu-  <li\isi(in  have  been  partici- 
jiated  in  by  the  State  health  agency  since  its 
creation  in  ls77  the  work  was  not  centralized 
nor  carried  on  in  a  systematic  way  until  l!)ir) 
when  the  bureau  of  medical  and  sanitary  in- 
spection was  established.  Prior  to  that  time 
the  field  work  was  done  by  the  secretary  him- 
self or  ])h\sicians  or  lay  quarantine  officers 
emploved  on  a  per  diem  basis.  Sometimes 
the  physicians  so  eiuployed  were  members  of  t>'-  ■'■  ■'■  iiiSiiMne. 

the  State  Board  of  Health.     More  often  they 

were  not.  Beginning  about  1!)00  a  scheiue  was  devised  whereby  a  number  of 
])hv>icians.  located  at  convenient  jwints  in  the  State,  agreed  to  accept  appoint- 
ment for  temi>orar\-  dutv  whenever  called  upon  and  receive  therefore  remun- 
eration at  a  sti])ulatt(l  per  diem  rate.     This  method  of  handling  communic- 


PUBLIC    HEALTH    ADMINISTRATION  211 

able  diseases  continued  until  July,  HH.").  when  it  was  converted  into  the 
bureau  of  medical  and  sanitary  insi)ection  with  a  definite  amount  of  money 
appropriated  sufficient  for  eniplo}ing-  a  medical  staff  of  five  and  specific 
duties  assigned  to  it. 

By  early  spring  of  1916  the  necessary  civil  service  examinations  had 
been  held  and  the  five  appointments  made.  They  included  Dr.  E.  S.  God- 
frey, who  was  designated  as  State  epidemiologist.  Dr.  C.  E.  Crawford,  Dr. 
C.  S.  Nelson,  Dr.  Clarence  W.  East  and  Dr.  I.  N.  Foster.  These  physicians 
were  assigned  to  field  duty,  each  covering  one  of  five  districts  into  which 
the  State  was  divided  for  that  purpose  and  all  were  placed  under  the  general 
supervision  of  Dr.  Godfrey.  Besides  these  district  health  officers,  as  they 
were  called,  there  were  attached  to  the  bureau  three  dairy  inspectors,  one  on 
a  full  and  two  on  a  part  time  basis  and  a  small  clerical  staff. 

In  r.iK,  with  the  adoption  of  the  Civil  Administrative  Code  by  the  State 
government  and  the  consequent  reorganization  of  the  health  service,  the 
bureau  of  medical  and  sanitary  inspection  became  the  division  of  communi- 
cable diseases  which  title  it  has  retained.  Funds  sufficient  to  employ  one 
chief,  one  superintendent  of  field  service,  six  district  health  officers,  two 
nurses,  two  (|uarantin_e  officers  and  a  clerical  staff"  of  five  were  appointed  to 
the  division.  All  of  these  positions  were  filled  although  the  two  nurses  and 
one  physician  were  utilized  in  another  type  of  service  and  formed  what  de- 
veloped into  the  division  of  child  hygiene  and  public  health  nursing.  Dr. 
J.  J.  AlcShane  became  the  first  chief  of  the  division,  on  August  1.  T.>1  i.  as 
a  result  of  a  civil  service  examination.  Dr.  McShane  has  continued  in  that 
capacity  to  date. 

During  the  ten  years  ended  with  June  -W.  \'.^'i].  the  field  personnel  of 
the  division  varied  considerably,  dtie  to  small  salaries  provided  in  the  early 
part  of  that  period  and  fluctuations  in  the  appropriations  made  from  time 
to  time.  In  I'JIO  a  total  of  $16,000  per  year  was  granted  for  the  employment 
of  district  health  officers,  with  maximum  salaries  specified  at  $2500.  The 
next  General  Assembly,  that  of  11)21.  raised  the  appropriation  for  medical 
field  personnel  to  $100,000  per  year,  set  $1,800  as  the  maximum  salary  and 
changed  the  title  of  the  positions  to  district  health  superintendents.  Tlie 
difficulty  of  securing  trained  men  delayed  the  filling  of  these  places,  how- 
ever, so  that  the  field  strength  never  exceeded  abotit  20  men.  Then  in  11>2;) 
the  sum  apjiropriated  for  district  health  superintendents  was  set  back  to 
$30,000  per  year  and  raised  ag.iin  \n  ^:,{).()\ut  in  1'.I2.'').  In  l!t2;  it  remained 
at  $50,000  with  the  maximum  salary  placed  at  $l,<iii(l,  which  had  been  set 
in  1923. 

The  amount  of  strength  actually  em])loyed  v.aried  about  as  the  ap])ro- 
priations  but  ne\er  up  to  the  maxinnim  i)ro\i(led  for.     ( )n  Jidv  1.  ]'.<'!]  there 


213  PUBLIC  iii;altu  ahmixistratiox 

were  13  district  lu-alth  superintendents,  including  a  chief,  at  work,  in  addi- 
tion there  werr  the-  (li\  ision  chief,  an  assistant  epidemiologist,  two  quarantine 
ofificers,  one  industrial  hygienist  and  a  clerical  staff  of  ten. 

All  (if  the  ])crsonnel  of  the  division  is  employed  on  a  full  time  basis. 
The  State  is  divided  into  districts  equal  in  number  to  the  number  of  district 
health  superintendents  employed.  Each  of  the  latter  maintains  headquarters 
in  tile  district  to  which  he  is  assigned  so  as  to  facilitate  field  service. 

It  has  been  the  practice  since  1921  to  hold  meetings  of  the  field  staff 
periodically  in  order  to  increase  the  efificiency  of  the  force  by  permitting  gen- 
eral discussion  of  their  problems  and  bringing  to  them  the  proper  interpre- 
tation of  policies,  plans,  programs  and  procedures  included  in  the  De- 
partment's services.  These  conferences  are  held  at  least  annually  and  some- 
times oftener. 

Bill  IS  (uid  Ixcgulatious  Pro))iiih/afcfL 

When  the  State  Department  of  I'ulilic  Ik-alth  was  created  in  IHK  the 
division  of  communicable  diseases  was  charged  by  the  Director  of  I'ulilic 
Health  with  making  rules  and  regulations  governing  quarantine  and  re- 
porting of  diseases,  with  the  collection  and  compilation  of  morbidity  reports 
and  with  epidemiological  investigations.  It  was  also  made  responsible 
for  the  distribution  of  such  biological  products  as  the  Department  furnished 
to  the  citizens  of  the  State.  Its  duties  also  included  the  promotion  of  local 
health  service. 

The  history  of  the  rules  and  regulations  dates  back  to  liSI]  when 
health  work  first  began  as  a  function  of  the  State  government.  For.  38 
years,  however,  there  was  nothing  very  specific  about  them  except  in  special 
cases.  When  yellow  fever  threatened ;  rules  were  promulgated  in  regard 
to  quarantine  at  Cairo.  When  smallpox  broke  out  there  were  rules  that 
required  isolation  of  patients.  At  one  time,  prior  to  ls'.i."i.  rules  reciuired 
the  vaccination  of  all  school  children  but  this  was  later  annulled  liy  a  coin-t 
decision.  Furthermore,  and  of  great  importance,  there  was  no  machinery  for 
enforcing  rules  once  they  were  made.  Cities  and  villages  had  authority 
to  make  rules  and  regulations  concerning  disease  control  and  the  same 
power  was  granted  to  counties  later.  Up  until  j!K)3  the  local  regulations 
fre(|uentlv  conflicted  with  those  of  the  State  and  then  confusion  arose. 

.\bout  the  only  rule  that  really  operated  satisfactorily  before  I'.M.")  was 
that  relating  to  the  liiuMal  of  dead.  This  rule  reciuired  permits  from  local 
registrars  before  bin'ial  and  its  purpose  was  to  primiote  conqilete  filing  of 
death  notices. 

In  fDl.")  all  the  quarantine  rules  and  regulations  were  codified,  and  the 
pro])er  local  officials  specified  as  the  person  to  whom  reports  should  be  made 


PUBLIC    HEALTH    Al  ).M  1  X  ]STK  ATI!  )X  "J  J  o 

This  step  clarilicd  the  air  of  confusicsn  making  it  plain  what  the  rules  were 
and  to  whom  reports  should  be  made.  Length  of  quarantine,  sanitary  pre- 
cautions on  quarantined  premises,  diseases  for  which  quarantine  should  be 
established  and  like  matters  were  detinitely  specified. 

Under  the  early  system  there  was  difficulty  in  getting  reports  of  con- 
tagious diseases.  Altogether  some  2,700  local  officials  were  included  in  the 
list  of  those  who  should  receive  reports.  Many  of  them  did  not  know  it. 
Others  who  received  rejiorts  had  little  inclination  to  pa_\'  the  postage  neces- 
sary to  send  them  in  td  the  State  Board  of  Health.  At  times  the  State 
Board  of  Health  sent  out  communications  asking  for  the  required  informa- 
tion. Sometimes  it  was  returned  and  sometimes  not  and  its  reliability  was 
questionable  at  best. 

In  ]!)]?  two  things  happened  that  helped  matters.  The  State  Director 
of  Public  Health  was  ajijicinted  collaborating  epidemiologist  for  the  U.  S. 
Public  Health  Service  w  itb  jirixilcge  of  supplying  local  health  officers  with 
postage  free  report  cards.  The  other  thing  was  the  establishment  of  the 
division  of  communicable  diseases  with  its  held  staff  on  ;i  full  time  basis. 
Reports  began  at  once  to  improve. 

There  was  still  the  difficulty  of  knowing  who  the  Ideal  health  officers 
were.  This  was  corrected  by  an  amendment  to  the  State  Board  of  ITealth 
Act  in  l!l■^3,  new  sections  being  added  as  follows: 

"Section  21.  Tlie  county  clerk  of  ever.v  county  under  townshiii  or,s;anizatioii 
shall,  annually  before  the  first  of  May  furnish  the  Department  of  Public  Health 
the  names  and  postofiice  addresses  of  the  supervisor,  assessor  and  town  clerk  of 
every  township  in  the  county,  the  date  when  their  terms  of  office  expire  and  the 
township  of  which  each  is  an  oiflcial.  The  county  clerk  of  every  county  not  under 
township  organization  shall,  annually  before  the  first  of  December  furnish  the 
Department  of  Public  Health  the  names  and  post  otfice  addresses  of  the  county 
commissioners  and  the  date  when  their  terms  of  oflice  expire. 

Section  22.  The  clerk  of  every  city,  incorporated  town  and  village  shall, 
annually  before  the  first  day  of  May  furnish  the  Department  of  Public  Health  the 
name  of  the  mayor  or  president  of  the  board  of  trustees,  the  clerk,  the  health  offi- 
cer and  the  members  of  the  board  of  health  and  this  list  shall  indicate  which 
person  is  charged  with  the  enforcement  of  quarantine  regulations. 

Section  23.  The  county,  city,  incorporated  town  or  village  clerk  shall 
promptly  inform  the  Department  of  Public  Health  of  vacancies  in  the  ofilces 
named  in  sections  21  and  22  of  this  Act  and  appointments  or  elections  to  fill  such 
vacancies." 

From  19"2;)  on  reiiorts  have  steadilv  im])rovc(l  in  lioth  jiromptness  and 
completeness. 

\\'ith  improvement  in  the  character  of  municij>al  health  departments 
it  appeared  wise  to  permit  a  wider  use  of  local  di.scretioii  in  connection 
with  quarantine  than  the  strict  letter  of  the  rules  would  permit  in  all  cases. 
Thus  in  1923  a  system  of  wdiat  is  known  as  modified  cjuarantine  regulations 
was  inaugurated.  By  means  of  this  arrangement  local  health  officers  wdio 
are  able  to  satisfy  the  State  Director  of  Health  that  they  have  the  facilities 


214  PUBLIC    HEALTH    AIIM  I  X  ISTUATIOX 

for  adequately  handling;  the  local  situation  may  receive  permission  to  prac- 
tice moditied  quarantine.  This  system  permits  the  isolation  of  a  ])atient 
in  a  room  to  himself  with  attendant  and  the  free  use  of  the  remainder  of  the 
house  by  other  members  of  the  ([uarantined  premises. 

Another  instance  of  the  changing  character  of  the  rules  was  the  in- 
clusion of  carriers  of  disease  within  their  scope.  Thus  persons  found  to  lie 
chronic  carriers  of  typhoid  fever  are  required  to  stay  out  of  occu])ations  that 
bring  them  into  direct  contact  with   food   supplies  of   other   people. 

('<ii/l(i(/i(iHs  Di.srasc  Bi  ports. 

Subsequent  to  1915  when  the  rules  were  first  codified  and  made  specific 
they  have  been  revised  many  times  i:i  order  to  conform  with  the  ever  in- 
creasing knowledge  about  handling  disease  and  with  the  changes  in  habits  and 
customs  of  the  people.  The  scope  of  the  rules  has  increased  also,  new 
diseases  being  added  to  the  notifiable  list  from  time  to  time  and  new  uses 
being  made  of  the  rules  as  preventive  measures.  Thus  in  VJ'io  a  rule  pro- 
hibiting the  sale  of  oysters  for  raw  consuinption  in  Illinois  was  placed  in 
effect  and  another  in  VJ26  prohibiting  the  sale  of  stearate  of  zinc  toilet 
powder  in  any  but  safety  top  containers. 

Reports  received  at  the  office  are  immediately  coiui)iled  on  forms  ar- 
ranged for  that  purpose  so  that  daily  totals  are  made  showing  the  incidence 
reported  by  counties,  principal  cities  and  the  State.  These  daily  reports  in 
turn  are  compiled  into  weekly,  monthly  and  annual  summaries.  The  filing 
system  enables  reference  to  be  made  to  counties,  cities  arid  townships.  This 
office  system  was  started  in  ISf.'l  so  that  reliable  data  are  axailablc  back 
to  that  time  but  figures  for  prexious  years  are  more  incomplete. 

A  system  of  spot  maps  and  weekly  ])revalence  charts  was  ado])ted 
in  1U24  and  a  systeyi  of  notifying  local  health  officers  of  the  prevalence  of 
disease  in  the  State  was  started  in  1926.  The  latter  is  a  weekly  service  which 
keeps  local  health  officers  informed  of  all  reported  cases  of  the  principal 
diseases  ;md  the  foci  of  iiift-cticjns  as  well. 

Liiirs  A jijil jiiiifi  In  Willi,'  (if  DirisiiDi. 

The  inqiortant  laws  affecting  the  activities  of  the  division  are  not  many. 
First  in  importance  was  the  .State  Board  of  Health  .\ct  of  ISTT,  which  reads 
ill  jjart,  as  amended  in  liJOT,  as  follows: 

"The  State  Board  of  Health  shall  have  the  general  supervision  of  the  inter- 
ests of  the  health  and  lives  of  the  people  of  the  State.  They  shall  have  supreme 
authority  in  matters  of  quarantine  and  may  declare  and  enforce  quarantine  when 
none  exists,  and  may  modify  or  relax  quarantine  when  it  has  been  established. 
The  board  shall  have  authority  to  make  such  rules  and  regulations  and  such 
sanitary  investigations  as  they  may  from  time  to  time  deem  necessary  for  the 
preservation  and  improvement  of  the  public  health,  and  they  are  empowered  to 
regulate  the  transportation  of  the  remains  of  deceased  persons.     It  shall   be  the 


PUBLIC    HEALTH    ADM  I  N  ISTKATIOX  215 

duty  Of  all  local  boards  of  health,  health  authorities  and  officers,  police  officers, 
sheriffs,  constables  and  all  other  officers  and  employees  of  the  State  or  any 
county,  village,  city  or  township  thereof,  to  enforce  the  rules  and  regulations 
that  may  be  adopted   by  the   State  Board  of  Health. 

It  shall  be  the  duty  of  the  State  Board  of  Health  to  investigate  into  the  causes 
of  dangerously  contagious  or  infectious  diseases,  especially  when  existing  in 
epidemic  form,  and  to  take  means  to  restrict  and  suppress  the  same,  and  when- 
ever any  dangerously  contagious  or  infectious  disease  shall  become,  or  threaten 
to  become  epidemic,  in  any  village  or  city  and  the  local  board  of  health  or  local 
authorities  shall  neglect  to  refuse  to  enforce  efficient  measures  for  its  restriction 
or  suppression  or  to  act  with  sufficient  promptness  or  efficiency,  or  whenever 
the  local  board  of  health  or  local  authorities  shall  neglect  or  refuse  to  promptly 
enforce  efficient  measures  for  the  restriction  or  suppression  of  dangerously 
contagious  or  infectious  diseases,  the  State  Board  of  Health  or  their  secretary, 
as  their  executive  officer,  when  the  board  is  not  in  session,  may  enforce  such 
measures  as  the  said  board  or  their  executive  officer  may  deem  necessary  to 
protect  the  public  health,  and  all  necessary  expenses  so  incurred  shall  be  paid 
by  the  city  or  village   for  which  services  are  rendered." 

Prior  to  this,  in  point  of  clironology,  wa.s  the  Cities  and  Milages  Act 
of  1872  that  gave  these  mtinicipalities  authority  to  establish  boards  of  health. 
Then  came  the  law  of  1901  that  created  boards  of  health  in  rural  districts 
by  making  countv  c(  inmissioners,  stipervisors,  assessors  and  town  clerks 
constitute  boards  of  health. 

A  law  was  enacted  in  1911  which  reijuirctl  employers  of  labor  to  protect 
employes  from  undue  exposure  to  poisonous  chemicals  used  in  manufactur- 
ing processes. 

The  State  health  officials  were  required  to  receive  reports  of  occupa- 
tional diseases  under  this  law  and  to  transfer  the  notice  to  the  State  factory 
inspector  for  disposition.  This  same  law  requires  monthly  physical  exaitiina- 
tions  of  all  em])loyees  engaged  in  certain  occupations  where  they  are  exposed 
to  lead  and  other  ])ois()nous  chemicals. 

In  1917  there  was  enacted  a  law  authorizing  the  ■'establishment  of  local 
health  departments  by  popular  vote  in  one  or  more  adjacent  towns  or  road 
districts.  Under  ibis  law  taxes  may  l)e  levied,  collected  and  spent  for  lu-.-ilth 
purposes  only. 

In  I'.iD.j  a  law  was  enacted  providing  free  I'asteur  treatment  f(ir  poor 
people  bitten  by  rabid  animals  and  in  the  same  year  the  Stale  i^oard  of 
Health  Act  was  amended  st)  as  to  require  the  appointment  of  antitoxin 
agents  in  every  county.  Then  in  T.i()7  a  clause  was  added  to  the  a|iprnpria- 
tion  law  providing  for  the  free  distribution  of  antitoxin.  In  1911  t\i>lioid 
vaccine  was  added  to  the  free  list  and  silver  nitrate  in  191.').  Later  the  law 
on  this  subject  became  general  so  that  the  Department  is  in  a  position  to  pur- 
chase and  distribute  whatever  biologies  may  be  deemed  necessarv  for  the 
preservation  and  improvement  of  the  public  health. 


216  ri'iii.u;  health  admi.nistkatiox 

In  i;i|5  what  is  known  as  the  Ojjhlhahnia  Nennaturuni  Law  was  en- 
acted. This  law  defines  ophthalmia  neonatorum  and  makes  it  the  duty  of 
physicians  and  niidwives  to  report  all  cases  immediately  upon  discovery. 

Dist rihiiUdii  (if  Biologies. 

The  (li>Iriliution  nf  free  state  biologies  began  in  IDOl,  when  the  legis- 
lature aijpropriated  $15,000  to  the  State  Board  of  Health  for  that  purpose. 
Diphtheria  antitoxin  was  the  only  product  included  at  that  time. 

l)istrihutii)n  was  accomplished  through  a  system  of  agents,  usurdly  a 
local  druggist.  This  agency  system  began  in  1905  when  a  law  was  passed 
requiring  their  appointment  and  providing  that  they  shall  handle  antitoxin 
approved  by  the  State  Board  of  Health.  Then  after  the  1907  act  they  be- 
came the  agents  for  distributing  diphtheria  antitoxin  supplied  free  by  the 
State.  By  1927  these  agents,  who  number  477,  were  handling  antitoxin, 
toxin-antitoxin,  silver  nitrate  and  typhoid  vaccine. 

The  biologies  provided  by  the  State  in  1922  included  the  following: 

Diphtheria  Antitoxin,  in  both  immunizing  and  curative  doses. 

Diphtheria  Toxin-Antitoxin,  for  active  immunization  against  diphtheria. 

Schick  test  material  to  determine  susceptibility  to  diphtheria. 

Silver  Nitrate  Solution  to  be  used  in  new  born  babies'  eyes,  as  a  preventive 

of  Ophthalmia  Neonatorum. 
Typhoid  Vaccine  tor  immunization  against  Typhoid  Fever. 
Smallpox  Vaccine  as  a  preventive  o£  Smallpox. 
Antirabic  Vaccine  for  prevention  of  rabies  In  humans. 

The  antirabic  treatments  are  available  free  to  poor  people  only  but  the 
other  products  are  free  to  every  citizen  who  needs  any  of  them  for  therapeu- 
tic use. 

Table  23  shows  the  amounts  of  biologies  distributed  during  recent  years. 


PUBLIC    HEALTH    AD.M  I XISTRATIOX 


217 


1 

38.416 
39,306 
60,409 
75,811 
79.500 
41.907 
29.047 
30.565 
16.630 

s 

til 

450 

730 

1,078 

1,717 

3,289 

295 

412 

870 

93 

s 

1,550 

839 

1.197 

1,886 

2,483 

407 

437 

805 

365 

! 

o  S( 

1 

i 

5 

7.474 
8,995 
16,586 
21,863 
24.590 
13,589 
10.109 
10.069 
5,340 

1 

z 

o 

H 

it 

10,528 
9,717 
16,564 
20,504 
20,437 
10,774 
5,752 
6,342 
3,640 

'A 
< 

il 

llli 

S 

°-3 

13,501 
14,166 
22,539 
29,844 
28,701 
16,842 
12,337 
12,479 
6,740 

S 

s 

July  1,  1918-June  30 
July  1,  1919-Junc  30 
July  1,   1920  June  30 
July  1,   1921-Jiuie  30 
July  1,  1922-Juuc  30 

1 

2I« 


I'UliLIC    lllCALTH    AD.MIXISTKATION 


PUBLIC   HEALTH    ADM  IXISTRATION 

Table  2'■^ — Continued. 
Toxin- Antitoxin. 


219 


St.vle  A 
sinsle  tr. 

Style  B 
three  tr. 

St.vle  C 
ten  tr. 

Total. 

4,106 
588 
793 

1,089 
212 

2,433 
1.147 
2.513 
2.679 
2,053 

6,539 

1,735 

3.306 

3,748 

5,929 

8,194 

6,768 

5,929 

10,825 

23,522 

Schick  Test  Material. 


No.  pkgs. 

Total  tests. 

July    1     1923  .lune   30,    1924          .              

181— 50-tests  ea. 
128— 50-tests  ea. 
285— 50-tests  ea. 
295— 50-tests  ea. 

9,050 

6.400 

14.250 

14.750 

889  pkgs.— 50-tests  ea. 

44,450 

Smallpox  Vaccine. 


No.  pkgs. 

Total  points. 

1,443— 10-points  ea. 

1,464— 10-points  ea. 

202— 10-points  ea. 

14.430  points 

14,640  points 

2.020  points 

3,109 

31.090  points 

A 

\TIRAIilIC 

Treatment. 

No.  pk'.s. 

Total. 

lulv  1,   1924-June  30,   1925 

56 

90  paiil 

77  pai.l 

for  In-  .statu,  31   jiaiil  for  personall.v 
for  b.v   state,   19  paid  for  personally 

56 

Inlv   1,  1925  .Jime  30,  1926 

121 

Jul.v  1,  1926-l)ec,    31.  1926 

96 

Total   distribution    

223  paid 

for  by  state,  50  paid  for  personally 

273 

I'Uin.lC    lllCAI.lll    ADMINISTRATION 


DniSIO.N    ()!■'    TrBERCULDSIS. 

'I'lu'  division  of  tulnTculosis  has  never  been  more  llian  a  skeleUm  unit 
of  the  State  Uepartmenl  of  Public  Jlealth,  Lii<e  most  of  the  others  it  came 
into  being  with  the  organization  scheme  that  was  adopted  July  ],  1917.  From 
the  beginning  it  has  been  inseparable  from  the  gen- 
eral office,  having  as  its  titular  head,  the  assistant 
directcjr  and  occupying  space  in  the  main  office. 

In  IHK  a  salary  of  -$2,800  per  year  for  a  chief 

of  ilu-  division  was  appropriated.    That  was  dropped 

in    1  !•!'.•  and  an  item  of  $],o"^0  per  year  for  a  sit- 

|ier\ising    nurse    took    its    ])lace    luit    no    nurse    was 

v\iT   ;i|ipi)inted.   the   entire    sum    lapsing   back   into 

ilic  treasury.     In   lH'il  there  were  two  items  in  the 

;ip|iro|iriation — one   of    •$.'), 000    per   year    for   a   su- 

n  ■  r     ■■ .    Ti  I  pervisor    of    sanatoria    and    one    of    ^],"i!oo     for     a 

i'"'""^''-  stenographer.      From    that    time    on   there    was    no 

change  made  in  the  a])propriations  for  the  di\ision  initil  I'.^'i',   when  an  item 

of  -$1,800  ])er  year  was  added   for  a  (|u,irantine  officer  ancl  investigator. 

The  princiiial  activities  of  the  di\ision  have  been  rather  of  a  liaison 
character  between  the  State  Department  of  I'ub- 
lic  Ilealth  and  other  agencies.  There  is  a  strong 
\iiUnUar\-  tuberculosis  association  functioning  in  the 
."^tate,  forty-eight  counties  having  taken  ad\antage 
of  the  law  authorizing  a  tax  levy  for  the  construc- 
lion  and  maintenance  of  sanatoria.  In  the  fol- 
lowing counties  the  Glackin  Law  has  l)een  ado])t- 
ed  b\'  .a  referendum  vote.  In  lifteen  of  these 
counties  sanatoria  have  been  built.  In  the  others, 
with  few  exceptions,  there  is  a  fund  for  the  care 
ami  treatment   (  f  the  tuberculous: 


II.  t.c'onard. 


Adams 

Alexander 

Boone 

Bureau 

rhanipaign* 

Christian 

Clark 

Clay 

Coles 

Cook* 


Crawford 

DeKalb 

DeWitt 

Douglas 

Fulton 

Grundy 

Henry 

Jackson 

•Jefferson 

Kane* 


Knox 

I^aSallc* 

Lee 

Livingston* 

Logan 

McDonough* 

McLean* 

Macon* 

Madison* 

Marion 


Menard 

Montgomery 

Morgan* 

Ogle 

Piatt 

Pike 

Randolph 

Rock  Island* 

Sangamon 

Scott 


Shelby 

Stephenson 

Tazewell* 

Vermilion 

Whiteside 

Will* 

Winnebago* 

Woodford* 


■  Count! 


PUBLIC   HEALTH    ADMIXISTKATIOX  2'U 

This  being  the  case  it  has  been  unnecessary  for  the  State  Department 
of  Pubhc  Health  to  maintain  a  strong  organizatiiui  for  service  in  that  par- 
ticular field. 

Dr.  George  Thomas  I'ahner.  assistant  director  of  the  State  Department 
of  Public  Health  from  1!JK  to  lll'.'l  acted  as  chief  of  the  division  diu'ing  that 
period.  In  August  V.)2l.  Dr.  I'almer  was  succeeded  in  his  dual  capacity 
1)V  Dr.  Thomas  H.  Leonard  who  has  continued  to  date  in  the  piosition. 

Divisiox  OF  !Saxitai;v  Excixei-^rixg. 

Previous  to  the  establishment  of  the  division  of  sanitary  engineering, 
the  State  Board  of  Heahh  carried  on  occasionally  in  a  limited  way  some  of 
the  phases  of  public  health  work  which  are  now  handled  by  the  sanitary 
engineering  divisions  of  modern  health  departments. 
These  activities  relating  to  sanitary  engineering 
were  carried  on  almost  entirely  by  engaging  tem- 
porary outside  assistance  or  by  cooperative  arrange- 
uKui   with  State  or  outside  agencies. 

In  1S7!)  the  State  Board  of  Health  gave  some 
attention  to  the  pollution  of  the  Illinois  River  1)\-  the 
city  of  Chicago.  In  1880  the  Board  had  stream- 
pollution  investigations  made  at  Chicago,  Peoria, 
Springfield,  Ouincy,  Rock  Island,  and  Rockford. 
The  records  indicate  that  in  1883  some  further 
sanitary   inspections   of   streams   were   made.      The  i^aui  Hansen. 

legislature  in  1885  appropriated  a  contingent  fund  to  engage  servico  of 
analysts,  observers,  and  other  assistants  for  examination  of  water  sui)plic> 
and  polluted  streams  in  the  State.  In  18SS  an  analytical  study  was  made  of 
the  quality  of  the  larger  rivers  in  Illinois  that  were  more  or  less  ]3olluted, 
the  samples  being  collected  over  a  [)eriod  of  si.x  months.  In  19i)U  engi- 
neers, not  regular  employees  of  the  Board,  were  engaged  to  investigate  the 
contamination  of  Mississippi  I\i\-er  at  Chester  by  sewage  from  the  Southern 
Illinois  Penitentiary. 

The  need  for  sanitary  water,  sewage,  and  stream-pollution  surveys 
apparently  becoming  more  and  more  realized  and  the  procedure  of  engag- 
ing part-time  occasional  outside  assistance  proving  not  sufficient,  the  Board 
adopted  a  resolution  in  1894  favoring  an  apisropriation  by  the  legislature 
of  money  to  the  University  of  Illinois  for  making  analyses  of  sam])les  of 
water  and  polluted  streams  at  the  laboratories  of  the  Universitv.  As  a 
result  such  analytical  studies  were  undertaken  at  the  L'niversitv  in  KS!).") 
tmder  the  supervision  of  Prof.  Arthur  William  Palmer.  The  approi)ria- 
tion  to  the  Universitv  at  that  time  for  additions  and   imijrovements  to  the 


'i'i'i  VVV.LH'    UI'.AI.ril    ADMINISTRATION 

clu-mical  lahnratory  was  -^ojioii.  'Hic  chemical  studies  of  the  waters  of 
llliiidis  at  the  L'liivcrsily  ])ossil)ly  ikjI  fully  meeting  the  needs  of  the  State 
Board  of  Health,  the  Board  in  IS'.il)  adojited  a  resolution  ])reliminary 
to  the  en^^^as^enicnt  of  the  services  of  I'rof.  John  II.  I.onL,f.  of  .Vorthwest- 
crn  I'niversity  .Medical  School  and  lac(]h  A.  llarnion.  a  ci\il  cnt^ineer  of 
I'coria.  to  investigate  the  (|uality  of  the  w.atcrs  of  lllimiis  River.  l're\ious 
to  this  time  the  Board  had  some  stream-jwllution 
studies  made  by  Professor  Long  and  the  results 
of  these  investigations  of  the  Illinois  River  are 
included  in  a  report  of  the  Board  issued  in  1901  en- 
titled "Saiiftiirv  IiiZ'cstifiatioiis  of  the  Illinois  River 
(iiiil   I'rihiilarics". 

The  decision  of  the  United  States  Supreme 
Court  in  favor  of  the  State  of  Illinois  and  the 
.Sanitary  District  of  Chicago  in  the  action  brought 
li\  the  state  of  Missouri  because  of  the  discharge 
of  sewage  from  Chicago  into  a  tributary  of  Mis- 
sissippi River  was  handed  down  on  February  19. 
studies  made  by  Professor  Long  and  his  associates 
at  the  reipiest  of  and  by  arrangement  with  the  State  Board  of  Health 
were  major  items  of  evidence  in  this  litigation  and  the  favorable  outcome 
of  the  State  of  Illinois,  was  based  to  (|uite  an  extent  uiion  these  investiga- 
tions. 

In  a  further  eft'ort  to  increase  the  extent  and  value  of  chemical  studies 
of  waters  and  streams  of  Illinois,  the  Board  in  19U(.!  entered  into  a  co- 
ojjcrative  agreement  with  the  State  Water  Siu'vey  located  at  the  Uni- 
versitA-.  and  which  had  developed  into  a  separate  unit  although  administered 
bv  the  L'niversitv  trustees  since  the  chemical  studies  (jf  the  v\  aters  of  Illi- 
nois were  started  in    1S!L3. 


Harry  F.  Ferguson. 

T.IOC.     The   report  and 


Siniitdii/   EiiijiiK  I  riini   Iiiir(<iii    EslahVislHi}. 

I!v  llM.'i  the  need  of  full-time  systematic  engineering  activities  became 
so  apparent  that  the  legislature  in  that  year  appropriated  funds  for  the 
estalilishmenl  of  a  sanitarv  engineering  bm'cau  under  the  State  Board  of 
llealth.  An  integral  part  of  modern  pii])lic  health  activities  is  sanitation, 
espet'iallv  that  relating  to  w.ater  supply,  sewerage,  and  stream  pollution, 
and  experience  appareniK  li.id  ^ho\\n  that  full  etticiencv  and  effectiveness 
could  not  be  olit.ained.  I'speciallv  to  nu'ct  increasing  demands  caused  by  the 
increase  in  po]>ulation  m  the  St.ate,  bv  the  engagement  of  outside  occasional 
services  and  cooperative  agreements  with  otiier  agencies  located  miles  away 
from  the   l!o,u-d  headquarters. 


PUBLIC    HEALTH    ADM  I  XISTRATIOX 


2  2;? 


The  first  appropriations  for  the  sanitary  engineering  biu-eau  provided 
for  a  chief  engineer,  an  assistant  engineer  for  field  studies,  an  assistant 
engineer  for  a  water  and  sewage  laboratory,  and  a  stenographer.  Paul  Han- 
sen   was    a])pointe(l    by    tlie    Board    of    Health    upon    the    reconimenchition 


160 

- 

140 

- 

/ 

120 

- 

/ 

100 

5cweraqe  and  stream  poUvilon                                                    /       / 

6t> 
60 

— — "  "      Scwerat^e                          \\                              /  , 

/  /' 

40 

V^'  / 

20 

. 

Strcom   pollution 

0 

■" 

1                     1                     1                     J                     1                     1 

151819        \9l9-aO        192021        I92RZ        1922-23       1923-2'^      1924-25      1925-26      1916-27 
FISCAL  VEAR5 

Fig.  13.    Number  investigations   made   b.v   sanitary   en,aineer  relative   to 
existing  and  proposed  sewerage  installations  and  stream  pollution. 


400 

r 

J50 

\                                                                                      ^^ 

300 

r                                                                        /""^ 

tSO 

:                                                     y 

100 

\                            ^~~~~~~^ 

150 

-            ^^^ 

100 

^^^"^^ 

50 

'- 

; 

Fig.  It.    Xumber  of  investigations  made  by  sanitary  engineers  ot  existing 
and  proposed  public  water  supplies  by  fiscal  years. 


224 


PUBLIC    HEALTH   ADMINISTRATION 


I9?l-2i  mZ-23  1923-24  19Z4Z5 

nSCAL     YEARS 


Fig.  15.    Niiml)er  of  inspections  made  by  sanitary  engineer.s  for  all  pur 
poses  by  fiscal  years  since  July  1,  1918. 


Fig.  Ifi.    Number  of  water  analyses. 


PUBLIC    HEALTH   ADM  IXISTRATION  T40 

of  Dr.  C.  St.  Clair  Drake  to  serve  as  chief  engineer  to  organize  the  new 
bureau,  and  later  Mr.  Jrlansen  agreed  to  continue  in  that  position  and  the 
aiijiointmeni  was  conhrnied  by  the  civil  service  commission  after  hold- 
mg  an  examination.  He  resigned  in  1 !»";;()  and  was  succeeded  on  Alay  !•")  of 
that  year  by  Harry  F.  Ferguson,  then  principal  assistant  engineer,  who  has 
continued  as  chief  sanitary  engineer  to  date. 

That  the  establishment  of  a  sanitary  engineering  bureau  by  the  1!»15 
legislature  was  a  sound  step  and  the  sanitary  engineering  activities  inet  a 
need  throughout  the  State  is  perhaps  best  evidenced  by  the  fact  that  the 
following  legislatures  have  from  time  to  time  increased  the  appropriations 
for  that  division  so  that  on  July  1.  192T  the  positions  in  the  division 
had  increased  from  three  engineers  and  one  stenographer  to  seven  engi- 
neers, three  bacteriologists  and  chemists,  one  supervisor  of  rural  sanita- 
tion, two  milk  sanitarians,  six  clerks  and  stenographers,  and  f(.iur  other 
assistants. 

Previous  to  the  adoption  of  the  Civil  Administrative  Code  in  IHIT. 
the  actixities  of  the  bureau  of  engineering  were  regulated  by  the  law  cre- 
ating the  State  Board  of  Health  as  amended  and  especially  that  portion 
of  the  law'  which  provided  that  the  State  Board  of  Health  shall  have 
■'general  .supervision  of  the  interests  of  the  health  and  lives  of  the  citizens 
of  the  State"  and  "authority  tu  make  such  rules  and  regulations  and  such 
sanitary  investigations  as  ihev  may  from  time  to  time  deem  necessary 
for  the  preservation  and  improvement  of   the  pulilic  health". 

In  accordance  with  this  law  the  Board  in  IDIO  adopted  the   following 

rides  and  regulations  relative  to  water  and  sewerage  installatioits : 

"(1.)  No  municipality,  district,  corporation,  company,  institution,  person 
or  persons,  shall  install  or  enter  into  contract  for  installing,  waterworks  oi  sewers 
to  serve  more  than  25  persons  until  complete  plans  and  specifications  fully  describ- 
ing such  waterworks  or  sewers  have  been  submitted  to  and  received  the  written  ap- 
proval of  the  State  Board  of  Health  and  thereafter  such  plans  and  specifications 
must  be  substantially  adhered  to  unless  deviations  are  submitted  to  and  receive  the 
written  approval  of  the  State  Board  of  Health. 

'■(2.)  No  municipality,  district,  corporation,  company,  institution,  person  or 
persons,  shall  make  or  enter  into  contract  for  making,  any  additions  to,  or  changes 
or  alterations,  in  any  existing  waterworks  serving  more  than  25  persons,  when 
such  additions,  changes,  or  alterations  involve  the  source  of  supply  or  means 
for  collecting,  storing  or  treating  the  water,  until  complete  plans  and  specifica- 
tions fully  describing  proposed  additions,  changes  or  alterations  have  been  sub- 
mitted to  and  received  the  written  approval  of  the  State  Board  of  Health  and 
thereafter  such  plans  and  specifications  nnist  be  substantially  adhered  to  unless 
deviations  are  submitted  to  and  receive  the  written  approval  of  the  State  Board 
of  Health. 

"(3.)  No  municipality,  district,  corporation,  company,  institution,  persons 
or  person,  shall  make  or  enter  into  contract  for  making,  alterations  or  changes 
in  or  additions  to  any  existing  sewers  or  existing  sewage  treatment  works,  serv- 
ing more  than  25  persons,  until  complete  plans  and  specifications  fully  describing 
such  alterations,  changes  or  additions  have  been  submitted  to  and  received  the 
written   approval   of  tlie   State   Board   of   Health   and    thereafter   such    plans   and 


2'H>  iTiu.ic  iii;ai.tii  admimstkation 

specifications  luiist  be  substantially  adhered  to  unless  deviations  are  submitted 
to  and  receive  the  written  approval  of  the  State  Board  of  Health. 

"(■1)  Any  municipality,  district,  corporation,  company,  institution,  persons 
or  person,  owning  or  operating  a  water  purification  works  or  sewage  treatment 
works  shall  submit  to  the  State  Hoard  of  Health  monthly  records  showing  clearly 
the  character  of  effluents  produced. 

"(T).)  No  municipality,  district,  corporation,  company,  institution,  person  or 
persons,  shall  offer  lots  tor  sale  in  any  subdivision,  unless  within  the  boundaries 
of  an  area  incorporated  as  a  municipality  or  sanitary  district,  until  complete 
plans  and  specifications  for  sewerage,  drainage  and  water  supply,  have  been 
submitted  to  and  received  the  written  approval  of  the  State  Board  of  Health  and 
thereafter  such  plans  and  specifications  shall  be  substantially  adhered  to  unless 
deviations  are  submitted  to  and  receive  the  written  approval  of  the  State  Board 
of  Health. 

"(6.)  No  natural  Ice  shall  be  furnished  or  vended  to  the  public  for  domestic 
purposes  until  the  source  of  the  ice  supply  has  received  the  written  approval  of  the 
State  Board  of  Health,  which  approval  is  revocable  upon  evidence  being  pre- 
sented  or  discovered   of  undue  contamination  entering  the  source." 

The  Civil  Administralive  Code  placed  upon  the  Department  of  Public 
Health  all  of  tlie  dtttie.s  and  powers  of  foniier  Iniards  of  health  in^-ofar  as 
the  sanitary  engineering-  activities  were  concerned,  and  in  addition  provided 
more  delinile  duties  relruive  to  \vater-su])])lv  and  sewerage  installations  by 
providing  that  the  ])epannient  of  Public  Health  shall  have  authority  as 
follows: 

"To  act  in  an  advisory  cajiacity  relative  to  pulilic  water  sttpjilies,  water- 
])urillcation  works,  sewerage  systems,  and  sewage-treatment  works,  ;uid  to 
exercise  supervision  over  ntiisances  growing  out  of  the  operatimi  of  such 
water  and  sewage  works,  and  to  make,  pronudgate.  and  enforce  rules  and 
regulations   relating  t(j   such  iniisances : 

"To  m.iini.ain  chemical  and  biological  laboratories,  to  make  examinations 
of  mills,  water,  sewage,  w.iles.  ,ind  other  substances  as  may  be  deemed  neces- 
sary for  llie  prolcclion  of  the  people  of  the  State". 

The  w.ater  supply  and  sewiTage  rules  adopted  in  111  1(1  h.ave  never  formal- 
ly been  rein-aled,  but  ihey  are  jiracticall)-  \<iicl  in  A'iew  of  the  pr(n-isions  of 
tile  Civil  Ailminisiralive  Act  of  I'U].  In  accordance  with  that  .\ct  rules 
and  regidaiions  relating  to  sewage  nuisances  have  been  adopted. 

In  l!)".'"i  (he  Department  of  I'ublic  Health  adopted  a  Railway  Sanitary 
Code  in  confdinruice  wilh  a  Standard  Railway  Sanitarv  Code  i)repared  and 
recommended  by  the  Conference  of  State  and  Territorial  Health  Ofiflcers 
in  cooper.iiion  with  the   Cnited  States  Public   Health  Service. 

The  legislature  in  1  !••.'•")  enacted  a  law  relating  to  milk-pasteurization 
])lants  and  instructing  the  Department  of  Public  Health  to  adopt  and  enforce 
nn'nimum  i-ei|uirements  for  ]iasieurizalion  (ilants  in  accordance  with  the  law. 
These  mininnnn  re(|uirements  have  been  pre])ared  and  the  wnrk  rei|uired  by 
the  law  and  the  en  forci'uient  nf  the  re(|uirenients  have  been  carried  on  In-  tlv.' 
sanitar\-  I'nt'ineerini'"  di\isi(in. 


-  J 


238  l'l"!!l,K     lli.AI.llI     \IIM  IXISTRATIOX 

PrhiciiHil  Arf'irilirs. 

']'1h'  tiilldwini;  art-  tin-  iirincipal  activities  ol'  the  division  of  sanitar\' 
enginecriiif^ : 

1.  Investigation  and  appnival  of  proposed  new  or  improved  public  water- 
supply  projects  and  examination  of  and  advice  relative  to  existing  public  water 
supplies,  including  water-purification  plants. 

2.  Investigation  and  approval  of  proposed  new  or  improved  public  sewer- 
age projects,  including  sewage-treatment  plants,  and  examination  of  and  advice 
relative  to  existing  sewer  systems  including  sewage-treatment  plants. 

?<.     Investigation   of  stream   pollution. 

4.  Investigation  of  methods  for  the  purification  of  water,  sewage,  and  other 
liquid  wastes. 

5.  Water  and  sewage  laboratory  service. 

6.  Examination  and  certification  of  water  supplies  for  use  on  common 
carriers  in  cooperation  with  the  United   States  Public  Health  Service. 

7.  Investigation  and  advice  relative  to  rural  sanitation  including  water 
supplies,  sewage  disposal,  camps,  summer  resorts,  fairgrounds,  country  schools, 
etc. 

8.  Examinations  of  and  advice  in  regard  to  swimming  pools  and  liathing 
beaches. 

9.  Investigate  and  report  on  the  prevalence  and  control  of  mosquitoes, 
especially  in  those  areas  where  malaria  is  a  public  health  problem. 

10.  Investigate  milk-pasteurization  plants  and  issue  certificates  to  those 
plants  complying  with  the  State  law. 

11.  Advice   relative   to  municipal  plumbing  ordinances. 

12.  Advice  relative  to  local  nuisances  and  insanitary  conditions. 

13.  Investigation  of  diseases  that  may  be  water-borne,  such  as  typhoid  fever 
and  enteritis,  in  cooperation  with  the  division  of  communicable  diseases. 

14.  Investigation  of  sanitary  condition  of  school  buildings. 

15.  Investigation  of  sites  for  tuberculosis  sanatoria  with  special  reference 
to  water  supply,  sewage  disposal,  and  drainage,  as  a  basis  for  approval  of  such 
sites  as  required  under  the  State  law. 

16.  Studies   of   city   waste  collection   and   disposal   and   street   cleaning. 

17.  Filtration  and   distribution   of  State   House   drinking-water   supply. 

IS.  Educational  work  by  means  of  publications,  addresses,  exhibits,  and 
correspondence. 

The  luiniher  ol'  total  investigations  made  hy  the  staff  of  the  division 
since  slalistical  records  were  keiH  are  graphicallv  shown  in  Figures  13  and 
I  I.  and  the  number  ot'  investigations  made  relati\-e  to  different  subjects  in- 
cluded in   the  divisional  activities,  are  illustrated  in    h'igures  l.'i   to   IS. 

No  atteni]it  will  be  made  to  indicate  any  otitstanding  activities  of  the 
division  during  the  twelve  year^  that  it  has  been  functioning  as  a  ])art  of  fifty 
years  of  ]iit])]ic  health  work'  by  the  .'-itate  of  Illinois  because  some  activities 
which  nia\  ;i|i|iear  to  be  moi'e  iniportant  possiblv  are  less  important  tli;in 
some  other  a])])arentlv  minor  aclixilies  of  the  dixision  if  all  the  restllts  ob- 
tained cciuld  be  definitelv  measured,  b'or  examjile.  the  acti\-ities  of  the  di- 
vision during  floods  and  tornadoes  which  have  occurred  in  dilYerent  parts  of 
the  Stale  are  more  or  less  siiectacular  ])ut  the  net  result  frcjin  the  standpoint 


PUBLIC   HEALTH   ADMINISTRATION 


229 


Fi(i.  17.    Public  water  supplies  installed  by  years  in  iiuinic 
Illinois. 


DECADES 
Fig.  is.    Population  served  from  public  water  supplies  in  Illinois. 


230 


I'UHLIC    HEALTH    ADMIXISTRATIOX 


of  lowered  morbidity  from  ])reventable  diseases  and  better  and  more  health- 
ful (.-onditions  may  be  acuially  less  than  that  resulting-  from  routine  work 
and  what  might  be  tt-rmcd  by  some  as  "minor  activities"  such  as  bringing 
about  the  abandonment  of  cross-connections  between  ])ol!uted  and  safe  water 
su])plies  here  and  there  as  they  are  found,  the  rcjulinc  checks  on  the  ([uality 
of  public  water  su])plies  and  sanitar\-  disposal  of  sewage,  advice  and  assist- 
ance relative  to  rural  sanitation,  routine  insj)ections  of  milk  plants,  and  other 
features  making  up  the  daily  activities  of  a  modern  sanitary  engineering 
dixision. 

The  installation  of  public  water  supplies  in  nninici|)alities  and  the  popu- 
lations served  from  such  su|)plies  during  the  early  jieriotl  compared  with 
the  later  decades  are  an  index  of  the  advance  in  sanitation  and  the  civil  and 
sanitarx-  engineering  activities  throughout  the  State  during  the  period  since 
and  fvcn  j)re\-ions  to  the  establishment  of  the  Board  of  Health. 

In  a  chroiiological  record  or  history  of  jniblic  health  activities  accom- 
panying this  treatise  on  fifty  years  of  public  health  in  Illinois  some  of  the 
activities  of  the  division  of  sanitary  engineering  arc  included,  but  as  stated 
above  the  net  ronlt  in  the  decrease  in  the  niorbiilit\-  and  mortality  rates  from 
certain  diseases  and  the  general  improvement  in  public  health  may  not  be  as 
great  from  some  of  these  items  as  from  the  routine  activities  which  have 
not  ])efn  listed  but  which  would  be  too  numerous  to  include  in  a  chronologi- 
cal rec<ir(l  of  that  kind. 


Divisio.x  ()!•'  Vital  Statist^ics. 

The  registration  of  births  and  deaths  was  from  the  very  beginning  an 
im]iortam    factor   in   the  agitation    for   State   public  health  service.     It  has, 
therefore,  been  a  matter  of  concern  to  the   State  health  officials   since  the 
creatioti  of  the  State  Board  of  Health  in  1S7T. 

I'robabh-  no  other  problem  has  been  so  complex 
.iinl  imzzling  and  few  things  in  the  whole  history 
of  pulilic  he.'dlh  service  have  been  the  object  of  so 
nuicli    legislation. 

Mow  to  grt  complete  and  ]irompt  returns  of 
liirtbs  and  deaths  has  been  the  ])erpetual  question 
that  pursued  the  executive  officer  of  the  .State  health 
ser\ice  vi-ar  in  and  year  out.  Some  made  valiant 
atteni|)ts  to  collect  and  compile  the  statistics  while 
Av.  II,  ii.,yt.  others  appear  to  ha\-e  regarded  the  task  as  too  great 

to   justif\-   the    expenditure    of    eti'orts    necessary    to 
its  achievement  and  let  it  go  at  that. 


PUBLIC    IlKALTll    ADMIXISTKATIUX 


2■^] 


The  law  i-c(|uirr(l  all 


Eaiii)  Ejf()ii.s  to  Collect  Records  of  Births  ami  Dcailis. 

Thus  at  the  very  beginning  in  18^7  an  honest  effint  was  made  to  col- 
lect vital  statistics.  In  Deccml  cr  of  that  year  forms  were  preiiarcd  liy  the 
State  Board  of  Health  ami  vent  out  to  county  clerks 
certificates  of  births  and  deaths  to  be  liled  with  the 
county  clerks  whose  duty  it  was  lo  make  summaries 
of  their  records  and  forward  them  to  the  State 
Board  of  Health  on  forms  su[i[ilie(l  for  that  pur- 
pose. 

'J'he  whole  business  was  new  so  that  it  re(iuired 
some  little  time  to  get  the  procedure  started  with 
any  degree  (jf  satisfaction.  The  indomitable  and 
indefatigable  Ranch,  who  was  secretary  of  the 
Board  for  most  of  this  early  period,  kept  steadfast- 
ly- at  the  job,  however,  until  he  was  able  to  get  suf- 
ficient returns  in  1881  lo  publish  the  data  collected  Orin  Diiiy. 
for  that  year.  The  tables  list  death  statistics  for  '.)■')  of  the  103  counties  for 
1881  and  for  78  in  both  1882  and  1883.  There  were  80  counties  listed  in 
the  tables  for  188J:  while  the  returns  for  1885  and  1886  presumably  repre- 
sented registration  from  all  of  the  counties.  Birth  reports  were  published 
for  some  of  these  years. 

But  registration  was  far  from  complete  during  any  of  this  time.  In 
188.")  the  secretary  of  the  State  Board  of  Health  estimated  the  deficiency 
in  birth  registration  was  abotit  48  per  cent  and  that  for  deaths  about  ol. 

\fter  1886  no  birth  or  mortality  statistics  were  prepared  for  publication 
until  \'.Hri.  In  the  meantime  there' seems  to  have  developed  the  attitude  that 
it  was  practically  impossible  to  get  reliable  data  under  the  law  and  little  time 
was  lost  in  trying.  Dr.  Ranch  recognizing  the  weakness  in  the  law,  reported 
to  the  Board  in  l88(j  that  he  had  been  too  busy  with  other  matters  to  engineer 
an  amendment  or  a  new  law  through  the  legislature. 

.\t    the   quarterly   meeting  of    the    State    B(jard    of    Health    in    January, 

l.s'.)'.t  the  secretar}'.  Dr.  Egan,  reported: 

"Under  the  law  now  in  force,  all  physicians  and  accouchers  are  required, 
under  penalty  of  ten  dollars  to  be  recovered  in  any  court  of  competent  jurisdic- 
tion in  the  State,  at  suit  of  the  County  Clerk,  to  report  to  said  clerks  all  births 
and  deaths  which  may  come  under  their  supervision.  The  County  Clerks  are 
required  also  to  report  to  the  Board  all  births  and  deaths  reported  to  them. 
This  system  of  collecting  statistics  is  so  imperfect  as  to  make  the  returns  of 
no  practical  value.  The  law  has  been  inoperative  for  over  ten  years.  When  an 
attempt  was  made  to  enforce  it,  it  was  found  that  very  few  physicians  com- 
plied with  the  statutes,  and  that  this  Board  has  no  power  to  compel  them  to  do  so." 

There  were  two  principal  factors  that  operated  against  satisfactory 
registration  of  vital  statistics  during  all  of  the>e  \ears.  One  was  an  in- 
adequate law  and  the  other  was  lack  of  clerical  machinery. 


2-3-> 


I'l'BI.ir    lll.AI.III     ADM  IMSTKATinX 


H'o/Vr  Lnffft. 

Tlui^  ihc  opc-ninj,^  o\  i\\v  ninct(,-cntli  century  fiiunil  lioth  the  system 
and  the  registration  of  vital  statistics  in  a  rather  chaotic  condition.  About 
that  time  matters  began  to  take  on  a  brighter  aspect.  Dr.  Egan,  secretary 
III  ilic  St;ite  lioard  of  iieahh,  managed  to  get  a  new  law  enacted  in  1901. 
It  re(|uired  burial  permits  friim  county  or  town  clerks,  according  to  the 
type  of  governiueni  organization  in  the  counties.  It  also  provided  a  fee 
of  So  cents  each  to  go  to  the  person  making  the  report  to  the  local  registrar. 
The  burial  jiermit  feature  was  the  backbone  of  the  system  and  its  enforce- 
ment would  ha\e  the  desired  results. 

About  this  time  Dr.  I'.gan  also  employed  W.  11.  Hoyt  to  have  charge 
of  the  \ital  statistic  work  of  the  Board.  In  r.Hi.'i  an  item  for  "registrar 
of  \ital  statistics"  appeared  in  the  aiipropriation  law  and  from  that  time 
forward  jirovision  was  regularly  made  for  a  regis- 
trar. 

l)r.  I'lgan  went  further.  He  sent  Mr.  Hoyt  to 
study  the  vital  statistics  system  employed  by  the 
State  Board  of  Health  in  Michigan,  which  was  con- 
sidered verv  good.  .\s  a  result  of  this  study  a  satis- 
factory method  of  handling  the  statistics  was  intro- 
duced in  Illinois. 

The  1!HI1  law  oi)erated  with  a  fair  degree  of 
satisfaction  to  the  State  bioard  of  Health  but  it 
provoked  formidable  ojjposition  in  the  counties  not 
under  township  organization  where  burial  permits 
could  be  issued  only  by  county  clerks.  That  often  entailed  considerable 
hardship  and  delay  in  coimection  with  funerals  so  that  a  general  jiolitical 
movement  to  repeal  the  law  entirel_\-  was  set  in  motion.  This  movement  was 
strong  enough  to  force  a  revision  so  a  new  law  was  enacted,  one  drafted  by 
the  secretar\-  of  the  State  Board  of  Health. 

This  law  pro\ided  for  birth  reports  to  Lie  made  direct  to  count\-  clerks, 
except  in  cities  of  .Mi.ooo  cr  more  where  the\-  should  go  to  the  health 
comnussioner,  and  for  deaths  to  lie  reported  direct  to  the  State  bSoard  of 
Health  exce]it  in  municipalilies  enforcing  a  burial  permit  ordinance.  A 
fee  of  ■^")  ceiUs  each   was   paid   to  the  one  making  the   report. 

Under  this  law  statistics  were  complete  enrugh  to  justif)'  comiiilations 
and  rejiorts   for  the  years  IIH)','  to  I'.ii:;  iticlnsi\'e. 

The  last  law  afTecting  vital  statistics,  the  one  now  operating  and  known 
as  the  model  vit.al  statistics  law.  was  enacted  in  l!M-i  after  having  failed 
in  two  |ireceding  attemjits.  It  provick  s  for  a  system  of  local  re,gistrars 
located    at    convenient    places   in    all    parts   (  f    the    .State.      b'ees   of   25   cents 


Slieldon  L.  Howard. 


PUBLIC    HEALTH    AD.M  1  \  ISTRATIOX  'i'.V^ 

each  are  paid  to  the  local  registrars  while  physicians  and  others  are  re- 
cjuircd  to  make  reports  as  a  luirt  of  their  professional  duty  to  society. 

Up  until  julv.  !'.)()•.'  \ital  statistics  received  hy  the  State  Board  of 
Health  were  summaries  compiled  liy  county  clerks  on  forms  sent  out  by 
the  Board.  Such  analysis,  recordint;'  and  fdinj;  as  was  possible  from  these 
records  was  a  relatively  simple  matter  and  reiiuired  a  relatively  small 
amount   uf  clerical  work. 

(  )n  August  "2S,  190"2,  a  communication  was  directed  to  the  count\ 
clerks  making  a  change.  It  requested  the  county  clerks  to  send  the  original 
certificates  to  the  State  Board  of  Health  specifying  that  this  would  be  con- 
strued as  fulfilling  the  re(|uircments  of  the  law.  This  change  was  effective 
July  1,  19U2. 

Manifestly  the  new  method  made  necessary  a  much  larger  amount  of 
clerical  work  on  the  part  of  the  State  Board  of  Health  and  required  some 
one  to  supervise  the  classification,  compiling  and  recording  of  the  cer- 
tificates. Thus  a  registrar  of  \ital  statistics  was  employed.  He  began 
to  function  in  the  spring  of  ]!)():!.  The  man  chosen  for  this  work  was  \V.  II. 
Iloyt  who  was  given  charge  of  the  bacteriologic  laboratory  started  in  VM)\ 
and  was  referred  to  in  the  dual  capacity  of  registrar  and  bacteriologist  in  the 
minutes  of  the  Board  for  July   liHiJ. 

Air.  Hoyt  continued  as  registrar  of  \ital  statistics  imtil  Alav  1."),  I'.iln 
when  he  was  succeeded  by  Dr.  C.  C.  Ellis  who  was  followed  in  turn 
on  March  I,  I'.Hl.  by  Dr.  T.  H.  D.  Gritfitts.  He  occupied  the  position 
until  llil."i  when  ( )rrin  Dillv  took'  over  the  work.  Mr.  Dillv  was  suc- 
ceeded in  IIMI  by  .^beldon  L.  Howard  who  has  continued  to  date  as  regis- 
trar of  \  ital  statistics. 

Thus  it  is  seen  that  the  work  of  the  dixisinn  of  vital  statistics  is  as 
old  as  the  State  public  health  service  itself.  -Vbimt  I'.Ki:!  it  Ijecame  suffi- 
ciently systematized  and  \r)luminiins  enough  to  re(|mre  a  special  corps  of 
workers  under  the  supervisicm  i-f  a  regislr.ir.  Tlicn  in  li'l.")  it  liecame  an 
important  unit  (if  the  original  organization  pl.ni  uf  the  sl.Ue  heilth  service 
and  received  a  special  appropriation  of  •t.'j.~)l)t)  per  \ear  a>  the  bureau  nf  \ital 
statistics.     That  amount  provided  for  a  registrar  and  four  clerks. 

hiijirdnnifiii  Afti'r  Xcir  Lair  ]]'(is  I'fissrd. 

The  bureau  of  \ital  statistics  became  the  <li\ision  of  vital  statistics  in 
]'.>]:  with  the  creation  of  the  State  Department  of  I'ubHc  I  le.dtli  and  fared 
well  in  the  ap])riipriations.  A  registrar,  and  assistant  registrar  and  nine 
clerks  were  proxided  with  $12,800  per  year  as  total  salaries.  This  cdutinned 
to  grow  until  Jii-i7  found  the  division  with  a  stat'f  of  2fl.  including  the 
registrar,  assistant  registrar,  medical  assist.ant.  twn  fulil  agents  and  clerical 
staff. 


234 


I'UIil.lC    IIICAI.ril    ADMINISTRATION 


Stalislics  thai  wcro  mt  conipklL'  aiul  never  so  reijarded  luu  which  were 
euiuplete  enough  in  show  llie  s^eiieral  trend  of  lieahh  ccin(Hliiin>  were  eul- 
lecled.  compiled  and  jjuhlislied  for  the  _\ears  ni  UK)-.'  tn  I'.Mo  inckisive. 
After  thai  a  perind  (if  cnnfnsinn  and  inicerlainty  set  in.  due  tn  the  death  of 
the  secrelar\  of  the  State  lliiard  nf  1  li'ahli  in  Ahirch.  IIMM.  and  the  change 
in  the  vital  statistics  law  in  l!)lo.  .\cc(n(lin>;l\-  im  cnnipilations  were  made 
f(ir  the  intervenins;  years  hetween  IIM;;  and  I'TlCi.  Summary  statistics  for 
liirth>  and  deaths  were  made  nj)  f(ir  IDlii  and  I'Ji;  Iml  nu  analyses  were 
made. 
Illinois  Adnnlliil  liila  Itcf/islratioii  Ana. 

Hv  I'.M.S  the  registration  system  was  working  satisfactorily  enough  to 
justifv  the  federal  bureau  of  the  census  to  accept  Illinois  into  the  U.  S. 
registration  area  for  deaths,  a  minimum  nf  IMi  per  cent  completeness  being 
required  for  that  purpose. 

It  was  slower  for  hirths  liiu  tifter  a  long  drawn  out  camjiaign  the  State 
w-as  admitted  to  the  L'.  .'-^.  hirth  registration  area  in    IM'.'-.'. 

Detailed  statistics  are  available  from  the  mortality  reports  of  the  bureau 
of  the  census  for  I'.M.s  and  subsequent  years.  The  division  has  published 
detailed  statistics  of  its  own  sinct-  \'Xl\.  Infant  mortality  rates  have  been 
published  by  the  division  aiuuially  >ince  IH'^'I  and  the  tables  include  tigures 
for  l!l'.'(l.  The  federal  reports  include  these  figures  for  \'Xl'l  and  suljse(|uent 
years. 

Division  oI''  ('iiii.u  IIygiexe  and  Public  Health  Xursixg. 
This  division  was  officially  created  by  the  legislature  in  1!M!)  but  like 
several  of  the  others  it  had  come  into  existence 
prior  to  that  time.  An  effort  had  been  made  to 
secure  an  appropriation  for  work  of  that  type 
in  l!il."i,  hut  it  failed  in  the  General  .\ssembly 
In  1!IK  an  item  providing  for  a  chief  of  a  divi- 
sion of  child  h_\-giene  and  ]iublic  health  nurs- 
ing |)assed  the  legislature  hut  was  vetoed  l)\- 
the  (lovernor. 

Xecessit\'.  however,  was  the  governing 
factor  in  bringing  together  a  staff  that  real!)' 
betian  child  hygiene  and  nursing  work  as  early 
as  i;il(i.  In  the  late  summer  of  that  year  at) 
epidemic  of  infaiuile  paralysis  appeared  in  the 
State  and  caused  the  State  Board  of  Health 
nr.  1. .  w.  Ka.-t.  ^^^   begin   work   that   was  calculated  to   relieve 

the  children  alTected.    .A  recurrence  of  the  ejiidemic  in  liiK  led  to  the  definite 


PUBLIC    HEALTH    ADNr  IXISTRATIOX  235 

creation  of  a  division  of  child  hygiene  and  ])ubHc  heahh  nursing  with  Dr. 
C.  W.  East  as  chief  and  two  nurses  on  the  staff,  all  df  whom  were  Ixirmwed 
from  the  division  of  communicable  diseases. 

This  arrangement  continued  until  July  I.  liMH,  when  an  approiiriation 
of  $22,480  for  salaries  and  wages  for  two  yearN  hccnm-  available  for  the 
division.  In  1921  an  equal  sum  was  appropriated  tn  meet  the  salaries  and 
wages  of  the  division  during  the  ensuing  two  years,  in  lic^'i  there  was  granted 
$45,600  and  in  1925,  the  sum  of  ii^lT.dlo.  The  appropriation  in  J'.f>:  for 
salaries  and  wages  in  the  divisiim  for  the  ensuing  biennium  was  $12:'),S-30 
and  provided  for  a  staff'  of  four  iihysicians.  sixteen  nurses,  ime  dentist,  one 
dietist  and  three  clerks. 

The  infantile  paralysis  wdik  which  ])recipitated  the  creation  of  the  di- 
vision involved  the  establishment  of  clinics  at  more  than  a  score  of  points 
in  the  State.  The  staff'  traveled  from  one  jilace  to  another,  holding  clinics 
weeklv  or  less  often  as  circumstances  permitted,  and  giving  such  aid  as 
could  be  provided  for  cripples  of  all  kinds  and  particularly  the  victims  of 
poliomyelitis.  This  work  soon  began  to  necessitate  considerable  curative  or 
corrective  service. 

Demands  for  crippled  children's  work  increased  instead  of  diminishing 
after  the  epidemic  subsided  and  formed  a  major  part  of  the  work  of  the  di- 
vision until  February  1.  l!i-M,  when  it  was  taken  over  by  the  [Hindis  Crippled 
Children's  Society,  a  voluntary  organization. 

The  ])urposes  of  the  division  of  child  hygiene  as  set  forth  in  the  organ- 
ization scheme  of  the  Department  are  td  combat  tht-  high  mortality  among 
children  by  promoting  child  health  service  in  the  various  communities 
throughout  the  State,  establishing  infant  welfare  stations  and  visiting  nurse 
service;  to  promote  medical  inspection  of  school  children;  to  disseminate 
information  and  advice  on  the  care  of  children  and  investigate  local  condi- 
tions aft'ecting  child  life.  .\lso.  to  have  general  supervision  of  the  nursing 
service  maintained  l)y  communities  and  by  extra-governmental  agencies  ;  to 
investigate  orphanages,  homes  and  hospitals  for  children ;  to  assist  in  the 
management  of  baby  health  conferences,  b.-iby  week  programs,  etc.,  and  to 
supervise  the  practice  of  midwivcs  with  special  reference  to  the  prevention 
of  blindness   from  infection  of  the   eyes  of  the   newborn. 

Dr.  ('.  W.  East  who  had  served  the  State  Board  of  Health  in  the  capacity 
of  district  health  officer  and  as  acting  chief  of  the  division  of  tuberculosis 
initiated  the  child  Ingienc  work  and  served  as  the  chief  of  the  dix'isidn  unlil 
Februarv,  I'.i'.'l.  Dr.  R.  t'.  Cudk  was  acting  chief  from  l-'ebruars-  td  jul\- 
1.")  when  Dr.  b'.dith  H.  Dowry  was  ap]idinte(l  tcmjiorarily  to  the  pdsitinn.  In 
October.  \'>'i'>.  Dr.  (irace  S.  W'ightnian  of  Cliicagd  liecame  chief  of  the  di- 
vision as  a  result  of  the  civil  service  e.NaminatidU  lu  Id  fur  the  purpuse  of  till- 


2'3()  l'\JUL\C    HEALTH    ADMIN  ISTUATIOX 

iiiij  the  ]in>^itinn  on  a  ]K'rniaiK'nt  basis.      She  has  continued  to  fill  the  place 
to  (late. 

X II I  .^1111/  Srrrirr. 

In  IIM'.I  a  slate  siiperxisur  dt'  pulilic  health  niu'ses  was  first  employed. 
Two  more  cities  were  added  to  the  list  of  cities  having  a  piihlic  health  nurs- 
ini;-  st-rvice.  A  movement  I'nr  the  standardization  of  public  health  nursing 
service  was  initialed  in  I'.i'.'O.  This  initial  step  tonk  the  fcjrm  of  an  agree- 
ment lietween  Slate  agencies  and  private  and  local  governmenial  agencies 
employing  public  health  nurses. 

r.\-  this  time  the  division  had  influenced  and  assisted  nine  cities  in 
establishing  well  organized  public  health  nursing  services.  In  addition  to 
this  a  large  number  of  visits  were  made  by  the  dilterent  members  of  the 
division  to  nursing  associations  for  demonstrations  and  instructions.  It  was 
not  easy  to  measure  specifically  the  value  of  this  service  but  face  to  face  con- 
tact and  personal  service  was  found  to  be  the  very  strongest  agenc}-  avail- 
able in  liuilding  up  the  public  health  throughout  ihe  State. 

In  lUV'i  the  pulilic  health  nurses  in  the  Slate  were  organized  into  dis- 
trict associations  through  the  activity  of  the  Slate  supervising  nurse.  Twelve 
new  communities  wei-e  infiuenced  to  establish  public  nursing  services. 

The  next  vear  a  survev  of  public  health  service  in  the  State  was  car- 
ried out  and  a  successful  campaign  for  enlarging  this  service  was  conducted. 
E\-er}-  cilv  in  Illinois  with  S. ()()()  or  more  population  with  the  exception  of 
two  had  some  form  of  acli\e  nursing  service  in  the  ])ul)Iic  schools  in  ^'.)^i3. 

In  l!i-^L  the  Slate  was  divided  into  foiu"  pulilic  health  nnrsing  districts 
and  a  State  mirse  assigned  to  e;ich.  The  policy  of  the  Department  was 
that  the  State  nurses  shculd  \-isit  the  counties  in  turn  in  a  consulting  and 
advisorv  capacitv.  Realizing  that  the  various  communities  had  somewhat 
different  jjroblems,  the  division  allem])te<l  to  help  select  and  establish  the 
])articu!ar  service  best  suited  to  the  local  needs. 

.\11  public  health  nurses  were  encouraged  to  communicate  freely  with 
the  Department  relali\e  to  local  problems,  so  that  e\ery  possible  assistance 
might  be  rendered.  Thai  \ear  Iwenly-lwo  counties  had  m  public  health 
inirsing  ser\ice  of  an\-  character.  .V  sin-\ey  in  IH'^I  showed  that  the  itum- 
ln'r  of  counties  with  public  health  nursing  service  totalled  l'^.  while  60 
counties  had  rural  ]inblic  health  nursing  serxice.  The  total  number  of  pub- 
lic health  nurses  in  the  Stale  was    IIS. 

lir/hr   liilhfl   ('nilfrri'liri'S. 

The  lirst  better  baby  conference  held  by  the  State  Beard  of  Health 
was  in  11)1").  when  ">'-'iO  children  wert'  examined.  With  ih.e  inauguration 
of  the  division  this  work  natiiralh-   fell  under  its  supervision. 


PUBLIC    HEALTH    ADM  I  X  ISTKATIOX 


237 


In  VJ21  the  holding  of  better  liaby  conferences,  which  had  previously 
lieen  confined  largely  to  the  State  fair  was  extended  to  include  any  point 
in  the  State  where  demands  existed.  I'hysicians  and  nurses  assisted  in 
thirteen  such  conferences  in  as  man\-  cmnities  during  that   \'ear. 

The  next  few  years  showed  a  rapid  development  of  this  acti\ity.  In 
1922  a  physician  from  the  division  organized  and  directed  65  better  baby 
conferences  in  the  State  with  a  total  of  l.iii;  children  examined.  In  li)23 
seventy-nine  conferences  were  held  at  which  i,S.")l  children  were  ex- 
amined. 

In  a  number  of  wavs  the  l!t2(i  conference  at  the  State  Fair  differed 
from  those  held  in  former  years.     In  (inler  tii  do  l)Oth  careful  and  painstak- 


The  State  Fair  Better  Babv  Conference  in  action — 1925. 


ing  work  the  number  of  children  entering  it  was  definitely  limited.  The 
Illinois  State  Medical  Society  cooperated  in  selecting  a  pediatrician  who 
acted  as  consultant  to  mothers  whose  babies  presented  defects  and  fault\' 
habits  about  which  they  should  be  especially  advised.  A  total  of  (ilM  chil- 
dren were  examined  against  1,485  in  1925.  The  limitation  of  numbers  did 
not  appear  to  produce  the  advantages  anticipated,  however,  so  that  in  1921 
the  conference  was  again  thrown  open  to  as  many  as  desired  to  come. 

The  opportunity  for  research  and  investigation  was  unexcelled  in  con- 
nection with  these  conferences.  In  order  lu  determine  the  relative  health 
conditions  prevailing  among  rural  and  urban  children,  an  analvsis  was 
made  in   1923  of  the  babv  conference  records   which   "ave   sufficient   detail 


V.'iN  ITIll.ir    lll-.AI.rii     ADM  I  MSTRATION 

to  hv  classiTicd.  As  a  rusull  of  this  undrrtakini^r  il  was  found  thai  a  ,u;r(jup 
of  .'i.ilt:!  rural  i)r(.'-school-a,ne  children  had  a  total  of  li.sdii  hii^rniticant 
physical  defects,  while  a  t,n''"il'  "'"  '-.l-i"  e'il\  children  of  similar  age  had 
a  total  of  onlv  :'i.lSS  defects.  This  indicates  that  children  in  rural  areas 
ha\e  ,i,nealer  net-'d  for  an  extension  of  the  pnhlic  health  service  than  do 
their  city  consins. 

Mali  ri/il  //  (iiul  I  njtuil   II  i/iiii  iir  Sciricf. 

Althoui;li  the  State  of  Illinois  did  not  accept  the  provision  of  the 
Shepherd-Towner  Act.  maternity  and  infant  hytjiene  services  were  not  neu;- 
Iccted.  In  r.)".'l  a  special  maternity  and  infant  hygiene  program  involving 
the  promotion  of  public  health  nursing  ser\ice  and  infant  welfare  stations 
was  inaugurated.  In  11)33  four  new  infant  welfare  stations  were  opened,  one 
at  Wilmington,  one  at  Steger,  ami  two  at  I'reeport,  one  of  the  latter  was 
for  white  children  and  the  other  for  colored.  A  series  of  nine  prenatal 
letters  were  i)repared  covering  the  important  phases  oi  ])renatal  care,  and 
sent  to  any  prospective  mothers  in  the  State  who  made  application  or  were 
listed  for  the  series. 

The  first  "Young  Mother's  Cluh"  was  formed  at  St.  Charles  and  the 
]ilan  is  to  form  similar  clubs  in  e\ery  county  in  the  State.  The  object  of 
these  cluhs  is  to  bring  to  young  mothers  the  very  best  scientific  informa- 
tion available  on  the  subject  of  child  care  and  to  stimulate  frequent  examina- 
tion of  baljies  b\'  the  familv  physician. 

Eight  additional  _\oung  mother's  clubs  were  organized  the  same  vear ; 
two  at  Duquoin,  two  at  Alounds  and  others  at  Hamilton,  Dallas  Citv  and 
I'lowen. 

Medical  K.idUiiiKitiiiii  (if  Sclioiil  ( 'li/hl  It'll. 

The  medical  examination  of  school  children  was  a  logical  se(|uence 
of  the  work  done  at  the  better  baby  conferences.  In  lic.'l  a  unif(irni  "school 
record  card"  lor  this  work  was  adopted.  The  next  vear  members  of  the 
staff  assisted  with  the  medical  examination  of  the  .")(), 0(10  rural  school  chil- 
dren, while  the  nnnil)er  in    I'.i'i:!  reached  60,000. 

In  1!'".'"),  the  uniform  record  card  was  somewhat  modified  to  assist 
in  obtaiiiiiig  tin-  ci  rrection  of  delects.  This  class  room  health  card  was 
designed  to  meet  the  request  of  teachers  for  a  record  to  be  left  in  the 
School  room  and  also  to  impress  upon  the  children  the  imjiortance  of  ob- 
taining and  maintaining  a  clehnite  standard.  .\n  especirdh-  designed  button 
having  on  it  "Illinois  1  lealth  lit'.'.")"  was  presented  to  the  children  coming  u[) 
to  the  standard  requirements. 


Gloria  June  Esper. 

The  first  of  the  two  children  who  were  each  stiven  a  one  hundred  per 

cent  perfection  rating  at  the  Illinois  State  Fair.     Examined  in  192:!. 


240  ruiiLic  iii;.\i,Tii  adai  ixisikatiox 

P.i  cause  of  a  ^ap  l)L't\vi.cii  ilii'  l)etler  l)al)y  conferences  and  the  examina- 
tion of  school  children,  in  nc.'-"i  ihc  jjre-school  examination  of  children  was 
inanj^'u  rated. 

A  |)re-scho!  1  examination  card  was  adopted  after  careful  consideration 
hy  a  committee  from  the  Illinois  Stale  Aledical  Society,  Illinois  State  Den- 
tal Society.  Illinois  [''ederation  of  Women's  Chihs  and  rejjresentatives  from 
the  division.  !  )nrini;  the  year  I'.r.'C,  more  than  40,000  cards  were  requested 
hv  public  health  mn-ses.  club  women  and  parent-teacher  association  groups. 

.\  ri\e  ve.ir  pre-school  health  campaign  was  undertaken  jointly  by  the 
Illinois  Federatic-n  of  Women's  L'Inbs,  Illinois  State  JMedical  Society,  Illi- 
nois State  Dental  Society  and  the  Illinois  State  Department  of  Public  Health. 
Up  tf)  date  members  of  the  disision  ha\'e  assisted  with  the  examination  of 
over  :,(KI0  pre-school  age  children  ;nid  abotU  10,000  school  children. 

K(l  iirciKiudl  Act  I  rifles. 

The  educational  acti\itics  of  the  division  of  child  hygiene  and  public 
health  nursing  h;i\e  been  numerous  and  dix'erse.  Very  early  in  its  history, 
the  (li\ision  prejiared  literature  on  a  variety  of  subjects  much  of  which  is 
still  being  distributed  .-ifter  m;iny   reprinlings  and  re\ision. 

Demonstration  work  naturally  centered  around  the  public  health  ex- 
hibits and  in  connection  with  special  health  programs  in  local  communities. 
At  the  State  fair  in  I'.Us  a  total  of  aSO  consultations  were  given  to  mothers 
b\  the  chief  of  the  (li\ision  ;tnd  the  medical  assistant  and  in  1923  this  num- 
ber reached  '.H)().  Similar  consultation  work  was  conducted  at  ])ractically 
every  fair  and  exposition  where  better  liaby  conferences  were  held. 

j\  very  imjiortant  and  rather  new  activity  w'as  the  inauguration  in  1037 
of  a  breast-feeding  demonstration  in  McLean  County.  This  was  done  under 
the  aus])ices  ami  with  the  full  coo]ieration  of  the  McLean  C'ountv  Medical 
Society  and  is  intended  to  function  for  two  years.  A  nurse  from  the  di- 
vision especiallv  trained  for  the  work  was  assigned  to  work  in  the  county. 

Lectures  assumed  a  large  place  in  the  educational  work.  Either  with 
or  without  moving  picture  reels  and  lantern  slides,  members  of  the  divi- 
sion wvvf  in  ,great  demand  not  onl\-  in  connection  with  fairs  and  expositions 
lint  ;it  meetings  of  women's  clubs,  parent-teacher  organizations  and  the 
like.  The  subjects  included  in  these  lectures  covered  a  wide  range,  such 
as  child  hv.giene  :ind  nursing  problems  and  allied  subjects  such  as  the 
model  milk'  ordin;inci-  and  tln'  toxin-antitoxin  campaign. 

Courses  of  instruction  to  nurses  and  teachers  seemed  to  be  especially 
popidar.  An  t-ight  wt'eks  course  for  graduate  nurses  in  commntiit\-  nurs- 
ing service  was  conducted  in  IHL'^. 


'<.r* 


i 


James  Robert  Craycrott. 

The  second  of  tlie  two  children  who  were  considered  perfect  in  pliys- 

ical  development  at  the  Illinois  State  Fair.     Examined  1924. 


242  rUBLIC    HKAI.TIl    AD.MIMSTKATIOX 

In  l!>"?.j  an  infant  mortality  survey  was  made  in  the  counties  rejjorting 
an  infant  iK'ath  rate  for  1923  of  100  or  more,  'i'here  were  nine  such 
counties.  Personal  visits  or  addresses  at  county  medical  society  meetings 
afforded  the  opportunity  to  present  the  matter  to  physicians,  women's  clubs, 
parent-teacher  associations,  etc. 

A  goitre  survey  was  made  during  11)27  in  the  Western  lllin(jis  Univer- 
sity at  Normal,  Illinois;  also  at  Decatur  among  both  high  schocil  and  grade 
school  pupils.     In  this  survey  over  3,000  pupils  were  examined. 

.\  child  hygiene  committee  consisting  of  Dr.  Harold  X.  Smith.  Chair- 
man, representing  the  Illinois  State  Dental  Society,  Dr.  B.  \'.  McClanahan. 
Galesburg,  representing  the  Illinois  State  Medical  Societ)%  Dr.  Lena  K. 
Sadler,  Illinois  Federation  of  Women's  Clubs  and  Mrs.  Blanche  Buhlig,  the 
council  of  Illinois  Parent-Teacher  As.sociations  met  with  the  chief  of  the 
division  once  every  month  to  discuss  ways  and  means,  policies,  cooperative 
plans  and  other  important  measures  related  to  child  health  needs  in  Illinois. 
Among  the  specific  accomplishments  of  this  committee  was  its  work  in 
promoting  the  toxin-antitoxin  campaign. 

The  chairman  of  the  educational  committee  of  the  Illinois  State  Medi- 
cal Society  sent  letters  of  information  to  the  officers  of  the  county  medical 
societies.  The  Dental  Society  through  letters  and  its  official  journals  urged 
the  cooperation  of  dentists  in  distributing  literature.  The  president  of  the 
parent-teacher  association  sent  out  over  700  letters  to  officers  of  her  or- 
ganization asking  their  help  in  distributing  80,000  circulars  on  toxin-anti- 
toxin to  the  membership. 

The  child  welfare  chairman  of  the  federated  clubs  wrote  letters 
to  the  child  welfare  chairmen  of  the  750  component  clubs,  outlining  the 
plans  of  the  State  Department  for  the  toxin-antitoxin  campaign  and  jilacing 
80,000  educational  leaflets  for  distnliiition  to  parents  of  young  children. 

Of  Jut  Adivitics- 

In  11123  pnictical  demonstrations  in  oral  hygiene  were  carried  out  in  four 
of  the  largest  cities  in  the  State,  namely  Mattoon,  Decatur,  Elgin  and  Spring- 
field by  a  federal  field  service  unit  working  at  the  request  of  the  State 
Department  of  Public  Health.  The  unit  consisted  of  Major  Butler  (who 
died  during  his  stay  in  Mattoon)  and  Miss  Verna  Thornhill.  From  200  to 
300  children  were  examined  in  each  city. 

In  connection  with  these  demonstrations  the  staff'  of  the  dental  unit 
carried  out  a  very  definite  educational  program  in  the  schools  and  gave 
talks  on  mouth  hygiene  before  organizations  wherever  opportunity  was  pre- 
sented. 


PUBLIC   HEALTH  ADMINISTRATION 


•^43 


An  important  expansion  of  the  activities  of  the  division  in  1926  was  the 
creation  of  a  section  on  dental  hygiene.  This  new  undertaking  was  financed 
tor  one  year  by  the  IlHnois  State  and  the  Chicago  Dental  Societies.  The 
major  emphasis  of  the  program  was  educational,  aiming  at  prevention  of 
dental  disease  through  fundamental  requirements  for  securing  the  develop- 
ment of  hard,  durable  teeth.  The  State  Dental  Society  through  letters  and 
its  ofiicial  journal  urged  the  cooperation  of  dentists  in  distriljuting  literature. 
The  1927  General  As.sembly  provided  for  taking  over  tiiis  work  by  the 
State. 

Among  the  many  miscellaneous  activities  of  the  division  was  the  render- 
ing of  emergency  nursing  service  in  the  area  devastated  by  the  tornado  in 
Murphysboro  and  West  Frank fcrt  in  192o.  Nurses  were  stationed  in  this 
territory  for  niunths  and  assisted  in  the  prexention  of  epidemics,  school 
ins])ections  and   made  home   visits. 

Division  of  Sukveys  and  liCHAL  Hygiene. 


The  division  of  surveys  and  rural  hygiene  came  into  lieing  in  IHI ;  w  lien 
the  sanitary  zones  established  around  military  posts  created  a  demand  for 
sanitary  surveys  of  an  intensive  character.  Its  functions  included  the  mak- 
ing of  house  to  house  sanitary  sttidies  of  communi- 
ties that  expressed  a  desire  for  that  sort  of  research  as 
a  jireliminary  step  toward  improving  local  health  con- 
ditions. Such  sttidies  were  carried  on  in  Rockford, 
I'^reeport,  Waukegan.  East  St.  Louis,  .Mton,  Moline, 
and  Ouincy  in  the  order  named,  the  first  being  done 
in  1!M;  and  the  last  in  1921.  The  surveys  were  ex- 
liau>ti\e  in  character  requiring  from  four  to  six 
months  in   one  community. 

Personnel    attacjied    to    the    division    was    never 
P:uii  L.  .Skoog.  large.      Sometimes    the   division    chief    bad    an   assist- 

ant and  sometinies  not.  fie  aKva)'s  had  a  steno- 
grapher. Field  work  was  accomplished  on  a  cooperative  plan,  the  local 
community   ])r(ividing  ;i   corps   of   five   to   ten   investigators. 

1';hi1  L.  Skoog  b;id  rli;irt;e  of  thr  division  from  llie  time  it  was  created 
uiiiil  .\birch.  192n.  JM-om  that  time  until  the  divisi(]n  lost  its  identity,  being 
fused  with  the  division  of  sanitary  engineering  in  tlie  spring  of  1921,  B.  K. 
Rich.'ii'dson  acted  ;is  its  chief. 


2i-k 


PUBLIC    liF.ALTII    AD.M  IMS  I  KATIOX 


IjABOKATOKY   W()I!K. 

The  year  l.STT  has  a  double  significance  fur  lUinuis.  When  the  State 
Board  of  Health  was  established  one  of  the  first  undertakings  was  the 
laboratory  examination  of  water  supplies, — an  activity  that  later  grew  into 

the  modern  laboratory.     The  same  year  at  Urbana 

I'rof.  Thomas  J.  Burrill  introduced  into  his  course 
of  Ijotany  at  the  Uni\ersit\-  of  Illinois  the  study  of 
bacteria.  Prof.  Burrill  was  the  first  teacher  in  the 
United  States  to  officially  recognize  bacteriology  by 
including  it  in  a  college  course  and  thus  initiate  what 
was  to  develop  into  an  entirely  new  science  having 
a  profound  influence  on  pulilic  health  ])ractice. 

The  foundation  of  jiublic  health  laboratory 
work  was  laid  by  Pasteni  in  France  in  the  period 
of  1SG.">  to  JS7().  when  he  demonstrated  the  germ 
theorv  of  disease.  In  England  Lister  began  his 
studies  on  aseptic  surgery  in  1867  transforming  surgical  methods  "from 
a  purgatory  to  a  paradise".  In  1875  Koch  first  grew  the  anthrax  bacillus 
in  pure  culture  while  other  investigators  were  working  with  other  diseases. 
In  1881  Koch  discovered  the  poured  plate  method  of  isolating  bacteria, 
following  which  in  rapid  succession  came  the  demonstration  of  the  bacilli 
of  tuberculosis  (1882),  Asiatic  cholera  (1883).  diphtheria,  tetanus  and 
better  recognition  of  the  typhoid  bacillus  (1884)  followed  by  many  others. 
Development  in  the  United  States  was  not  rapid  at  first.  In  1870. 
the  year  before  the  founding  of  the  Illinois  .'-^tate  Board  of  Health,  Bow- 
ditch  pul)lished  a  Cciitciiiiial  Surrey  af  tin-  State  of  Public  Hyciienc  in 
Auurica  in  which  no  mention  of  bacteria  was  made  and  Imt  one  reference 
to  the  germ  thenry  of  disease  which  was  in  connection  with  yellow  fever. 
Allhough  Burrill  liegan  teaching  his  students  about  bacteria  in  187 1.  it 
was  appariiitly  un{  until  1884  that  the  term  "bacteriology"  was  cdined.  In 
1.S84  and  1885.  several  colleges  and  universities  began  teaching  the  new 
science  as  a  separate  course. 

TIk-  lirst  nniiiicipal  ])ublic  health  laboratory  was  opened  in  1888  in 
Pro\  idence,  R.  I.  liul  for  several  years  this  devoted  it.self  entirely  to  the 
study  of  water  sup])lies.  Credit  for  the  first  modern  municipal  diagnostic 
laboratory,  therefore,  goes  to  New  York  Citv  in  1S!>:1,  followed  closelv 
bv  the  laboratory  of  the  (liicago  health  deparlnieiit  in  ISiM.  The  first 
state  public  health  laboriitory  was  that  of  KIicmIc  Island  established  the 
same  vear. 


I'URLIC    HEALTH   AD.MIXISTRATIOX 


245 


Lalxirafori;  ]\'iiiJi  hi/  Illinois  Stoic  Boar/I  of  Health. 

The  liistor\-  uf  lal(()rator\-  work  uf  the  IlHnois  State  Board  of  Health 
begins  with  the  estahHshnient  of  the  Board.  In  ISi;.  the  linancial  state- 
ment of  expenditures  included  an  item  of  $19.85  for  collecting  water  samples 
which  were  submitted  for  analysis  to  Prof.  BI. 
.\.  Weber,  chemist  of  the  Industrial  Univer- 
sity of  Champaign.  In  1880  the  records  of 
the  Board  mention  the  investigation  of  water 
supplies  at  Chicago,  Springfield,  Peoria. 
Quincy,  Rock  Island  and  Rockford.  In  1885 
the  legislature  appropriated  a  contingent  fund 
to  secure  the  services  of  analysts,  observers 
and  other  assistants  fur  examination  (jf  water 
supplies.  The  same  year  a  systematic  obser 
vation  of  tlie  varying  character  of  the  water 
su])])ly  of  Chicago  was  made  under  the  direc- 
tion of  the  ]-5oard.  Chemical  examinations 
were  made  weekly  by  Dr.  John  H.  Long.  Pro- 
fessor of  Chemistry,  Northwestern  University  in.  w  aitt-i  o.  Bam. 
Medical  School.  For  the  next  fifteen  years  Prof.  Long  conlintied  to  analyze 
water  at  intervals  for  the  State  Board  of  Health,  culminating  in  the  siud\ 
in  ]s;)!l  and  lilOO  in  connection  with  the  Chicago  Drainage  Canal.  Dr.  V . 
Robert  Zeit,  Professor  of  Bacteriology  and  Dr.  Gustav  Friitcrrer,  Pro- 
fessor of  I'athology.  at  the  Northwestern  L^niversity  Medical  School  also 
look   jiart   in  this   in\estigation. 

Since  no  laboratory  was  available  in  the  earlv  days  for  the  routine 
anah'sis  of  water  samples,  citizens  were  given  a  method  wherebv  thev 
could  test  their  own  sample.  Report  of  committee  on  school  hygiene  min- 
utes of  State  Board  of  Health,  1894. 

"For  examining  water  by  a  simple  method  take  a  sample  of  the  water  in  a 
bottle  cleansed  by  boiling  water  and  provided  with  close  fitting  glass  stopper, 
and  a  lump  of  loaf  sugar  and  place  it  in  summer  temperature  in  the  rays  of  the 
sun.  if  the  water  becomes  turbid  after  a  weeks  exposure  organic  matter  has 
decomposed  and  bacterial  multiplied,  the  water  cannot  be  regarded  as  whole- 
some and  must  be  boiled   or  filtered." 

(  )n  Decemljer  (!.  1S!M  the  committee  on  legislation  of  the  Slate  B)oard 
of  Health  .\uxiliary  Sanitary  Association  prepared  a  report  on  "needed 
legislation",  and,  among  other  recommendations,  passed  the  following  reso- 
luiions  ; 

"Whereas.  It  is  a  fact  of  familiar  knowledge,  that  certain  diseases  of  great 
fatality  are  caused  by  elements  of  poUuIioii  in  drinking  water: 

"Whereas,  Such  diseases  are  plainly  ineventable  by  proper  attention  to  the 
purities  of  the  sources  of  supply: 


246  I'UBLIC'    lllLAl/ril    All.MIXlSTRATIO.N 

"Whereas,  Such  attention  can  be  given  with  maximum  efficiency  anil  mini- 
mum expense  by  the  I'niversity  of  Illinois,  under  the  direction  and  authority  of 
the  State  Board   of  Health;   therefore,  be  it 

"Resolved,  that  the  Illinois  State  Board  of  Health  and  its  Auxiliary  Sani- 
tary Association,  earnestly  recommend  the  legislature  of  the  State  to  make  suit- 
able appropriation  for  the  establishment  and  maintenance  of  work  of  this  kind 
in  the  Institution." 

Also  the  following  resolution : 

"Resolved,  That  any  question  as  to  purity  of  food  and  medicines,  be  also  re- 
ferred for  analysis  to  the  authorities  of  the  University  of  Illinois  under  the 
direction  of  the  State  Board  of  Health." 

While  there  is  no  record  of  any  action  taken  on  the  latter  resolu- 
tion, the  legislature  in  1895  provided  -^.j.OOU  to  e(|uii)  and  maintain  a  water 
laboratory  at  the  State  University.  Professor  A.  W.  Palmer  of  the  De- 
[lartnient  nf  chemistry  was  put  in  charge.  The  .^tate  Water  Survey,  as 
it  was  known,  continued  as  the  agent  of  the  State  Board  of  Health  until 
1915,  working  in  close  co-operation  with  the  State  and  local  boards  of 
health.  In  the  latter  year  the  bureau  of  sanitation  and  engineering  of  the 
State  Board-  of  Health  was  formed,  which  took  over  the  analysis  of  water 
for  the  Board  although  the  Water  Survey  still  continued  sanitary  examina- 
tion for  many  local  boards  of  health. 

Food  analysis  ap])ears  in  the  records  of  State  Board  of  Health  in  1885, 
when  on  July  ol.  I'rof.  John  H.  Long  reported  the  results  of  a  chemical 
analysis  cf  meat  in  a  ])tomaine  poisoning  outbreak  causing  the  death 
of  one  person  .ind  the  illness  of  lhirt\-se\en  others.  He  also  made  micro- 
scopical examination  of  sections  of  the  meat,  reporting  the  presence  of 
bacteria. 

Food  laws  had  been  on  the  statute  liooks  since  IS  IT.  In  1885  the 
legislature  passed  an  additional  act  to  protect  the  ]iul)lic  from  im])osition 
in  relation  to  canned  or  preserved  foods.  Since  no  laboratory  facilities 
were  a\ail:il)le.  the  resolution  i|uote(l  abo\e  in  regard  to  analysis  at  the 
State  L'niversitv  was  recommended,  jjut  a]>i)arently  not  accejited  bv  the 
legislature. 

In  the  earl\-  nineteen  hundreds  the  .^tate  food  commission  was  or- 
ganized with  a  lal)oratory  in  Lhica';ii.  In  1!)()7  this  Commission  was  re- 
organized with  bro;'.d  powers  concerning  ftod  control  and  ample  laboratory 
facilities.  Co-o])eration  between  the  food  commission  and  Stale  lioard 
of  Health  was  intended  by  Section  32  of  the  jnire  food  law,  which  reads: 

"The  State  Board  of  Health  may  sulimit  to  the  superintendent  or  any  of 
his  assistants  samples  of  food  and  drink  for  examination  or  analysis,  and  shall 
receive  special  reports  showing  thr  n  suits  of  such  examination  or  analysis". 

The  first  mention  of  the  examination  of  di])htheria  cultures  appears 
in  the  recor(l>  of  the  Hoard  for  189  1.     (  )n  the  program  of  the  State  Board 


PUBLIC    HEALTH    ADMINISTRATION 


247 


of  Health  Auxiliary  Sanitary  Association  for  Nov.  14,  of  that  year,  ap- 
peared the  name  of  Dr.  Adolph  Gehrniann,  bacteriologist  of  the  newly 
formed  laboratory  of  the  Chicago  health  department.  In  his  paper  on  the 
"Bacteriological  Diagnosis  of  Diphtheria"  he  ])resente(l  the  feasibility  of 
establishing  in  every  city  and  town  which  has  a  board  of  health,  facilities  for 
the  prompt  and  positive  diagnosis  of  every  case  of  diphtheria,  at  trifling 
expense.  Demonstrations  of  his  method  were  carried  on  in  the  laboratory  of 
St.  Johns'  Hospital  at  Springfield. 

In  1S95,  according  to  the  Board  minutes  for  January,  18'.>6,  measures 
had  lieen  adopted  in  the  city  laboratorx-  in  C  hicagd  fur  the  pr(jnipt  and 
accurate  diagnosis  of  all  cases  of  diphtheria  as  soon  as  reported,  and  stations 
established  where  a  supply  of  diphtheria  antitoxin  could  be  promptly  ob- 
tained, free  of  charge  to  those  unable  to  pay.  This  work  was  started  in 
September  of  the  preceding  year. 

The  above  incidences  naturally  stimulated  a  demand  for  laboratory 
assistance  in  the  diagnosis  of  diphtheria  in  other  conmiunities,  for  the  fol- 
lowing item  is  found  in  the  minutes  mentioned  above : 

"Requests  were  received  from  Dixon  and  Grayville,  III.,  for  bacterial  ex- 
amination of  membranes  from  typical  cases,  from  diseases  prevailing  in  those 
cities,  with  a  view  to  settle  the  dispute  as  to  their  character.  As  is  known,  the 
Board  has  no  facilities  for  making  such  diagnosis,  but  through  the  kindness 
ut  Dr.  L.  C.  Taylor,  Bacteriologist  of  St.  John's  Hospital.  Springfield,  your  secre- 
tary was  enabled  to  furnish  the  desired  information." 

Ldbiinitniics  Esta1)HsJit'(J. 

In  I'.MII  the  State  diagnostic  laboratory 
was  organized,  and  in  19]  5,  the  first  branch 
laboratory  was  established. 

In  inn,  when  the  division  of  sanitation 
and  engineering,  as  it  was  then  called  organ- 
ized as  part  of  the  State  Department  of  Public 
Health,  a  water  and  sewage  laboratory  was 
created  which  has  worked  in  close  connection 
with  the  diagnostic  laboratory,  but  as  a  sep- 
arate  unit. 

The  biological  and  research  laboratories 
were  e-tablished  in   liJli). 

In  lli'^l,  the  division  of  social  hygiene  ob- 
tained money  fcir  additional  laboratory  service, 
whereby  the  services  of  three  technicians  for 
venereal  disease  work  in  Chicago  were  made 


Dr.  Thomas  i 


available  to  the  Chicago  health  department. 


248  I'UHI.IC    HF.AI.TIl    AD.MIMSTKATION 

Tlie  lalmratiiry  work  of  the  State  I X'liarlniciit  of  I'uhlic  Health  is 
(hvided  as  follows : 

Division  of  diagnostic  laboratories. 

This  includes  two  branch  and  eight   diphtheria   diagnostic   laboratories. 
Division  of  biological  and  research  laboratories. 

For  the  purposes  of  convenience   the   above   are   referred   to   as  the   di- 
vision   of   laboratories   and    administered    under   the   direction    of   the 
chief  bacteriologist  of   the   biological   and   research   laboratories. 
Division  of  engineering. 

Water  and  sewage  laboratory. 
Division  of  social  hygiene. 

Three  laboratory  workers  loaned  to  the  Chica.go  health  department. 

Laics  ruder  Which  the  Laboratories  Operate. 

The  original  Act  of  the  legislature  creating  the  State  Board  of  Health 
in  IST',  did  not  specify  the  maintainence  of  a  laboratory.  In  \'M)'  the  fol- 
lowing was  enacted  by  the  legislature: 

"The  State  Board  of  Health  may  establish  and  maintain  a  chemical  and 
bacteriologic  laboratory  for  the  examination  of  public  water  supplies,  and  for 
the  diagnosis  of  diphtheria,  typhoid  fever,  tuberculosis,  malarial  fever  and  such 
other  diseases  as  they  may  deem  necessary  for  the  protection  of  the  public  health." 

\\'hen  the  Department  of  Public  Health  was  formed  in  lUlT,  the  Civil 
Administrative  Code  (Sec.  55,  p.  39)  included  the  follow-ing: 

"To  maintain  chemical,  bacteriological  and  biological  laboratories,  to  make 
examinations  of  milk,  water,  sewage,  wastes,  and  other  substances,  and  to  make 
such  diagnosis  of  diseases  as  may  be  deemed  necessary  for  the  protection  of  the 
people  of  the  State; 

"To  purchase  and  distribute  free  of  charge  to  citizens  of  the  State  diphtheria 
antitoxin,  typhoid  vaccine,  smallpox  vaccine  and  other  sera,  vaccines  and  prophy- 
lactics such  as  are  of  recognized  efficiency  in  the  prevention  and  treatment 
of  communicable  diseases; 

"To  make  investigations  and  inquiries  with  respect  to  the  causes  of  disease, 
especially  epidemics,  and  to  investigate  the  causes  of  mortality  and  the  effect 
of  localities,  and  to  make  such  other  sanitary  investigations  as  it  may  deem  neces- 
sary for  the  preservation  and   improvement  of  the  public   health." 

Bit)l(i(/ie<iJ  ami  Bcsearch  Latxiratorics. 

( )ne  of  the  great  developments  in  the  application  of  bacteriology  to 
])ublic  health  occurred  in  the  period  of  ISIK)  to  IS'.)."]  wiili  the  production  of 
diphtheria  antitoxin.  Attention  was  focused  on  the  ])hen<imenuii  of  imnnni- 
ity  obtained  through  the  use  of  vaccines  and  serums  in  ]ire\enting  and  cur- 
ing disease.  Smallpox  vaccine  had  been  known  since  K'.Kl,  ;nul  it^  efiicacy 
well  established  by  the  time  the  State  Board  of  Health  was  formed.  Its 
use  was  continually  reconniiended  by  the  Board  and  in  ISS!)  there  was  an 
item  of  $500  to  be  expended  for  free  vaccination  against  smallpox. 

Reliable  smallpox  vaccine  was  not  available  at  that  time  ho\\e\er.  The 
science  of  bacteriology  was  barely  in  its  infancy  and  the  aseptic  lechnic  of 
Lister  had  not  been  ado])ted  by  veterinarians.  Sujiervision  of  biological 
products   was  not  attempted  by  the   federal  government  till    l')02.     Hence 


PUBLIC   HEALTH   AUM  I  X  ISTKATION  249 

niucli  uf  the  vaccine  of  that  period  was  lacking  in  both  putenc_\-  and  purity. 

An  interesting  report  depicting  the  conditions  of  the  times  was  nia<le 
liy  Dr.  (ieorge  Thilo  to  the  State  Board  of  Health  concerning  an  inspection 
in   June.  1S!I4,  of  the  Oak  Park  Vaccine  Farm. 

"The  stable  in  which  the  heifers  are  kept  during  the  incubation  period 
is  a  common  country  stable  for  about  twenty  animals,  presenting  a  low  ceiling, 
unplastered  and  uncoated  walls,  with  a  few  small  windows  and  a  wooden  floor 
with  two  outlets  for  stable  refuse.  Special  provisions  for  ventilation,  flushing  or 
disinfecting  the  stable  are  not  to  be  seen  there,  but  on  the  other  hand,  no  accumu- 
lation of  filth  is  noticeable.  In  other  words,  the  broom  seems  to  rule  there  ex- 
clusively     

"Tlie  operating  room  contains  an  apparatus  of  two  planks  and  a  strap  for 
wedging  in  the  animal  while  standing.  In  one  corner  was  an  ice  box  for  stor- 
ing lymph  in  the  warm  season;  some  pieces  of  soap  were  lying  on  a  window 
and  some  rags  hanging  on  a  rope. 

•'In  the  storing  room  on  one  side  a  wooden  box  filled  with  clean  points  in 
frames;  on  the  other  side,  an  open  place  (or  drying  lymph  on  the  points  and  two 
paper  boxes  with  vaccine  points,  one  6  bladed  rusty  knife  for  sacriflcation,  one 
kitchen  knife,  a  crystal  vase,  two  hair  brushes  and  a  fruit  jar.  No  disinfectants 
could  be  shown 

"Test  of  lymph  just  collected  frcnii  two  lieifers  showed  by  microscopical 
examination,  broken  down  tissue,  cell  detritus,  abundant  micrococci,  some  soli- 
tary bacilli  and  a  multitude  of  non-pathogenic  micro-organisms  frequently  ob- 
served in  the  dejecta  of  the  human  body." 

Included  with  this  report  were  stiggested  rules  for  the  application  and 
sale  of  vaccine  virus  in  Illinois,  but  no  record  a])i)ears  of  the  Board  adopting 
them. 

The  State  Board  of  Health  Auxiliary  Sanitary  Association  in  1894 
voted  to  ".\sk  the  legislature  to  make  provisions  for  the  establishment  of  a 
vaccine  farm  in  connection  with  the  University  of  Champaign,  under  the 
controlling  supervision  of  the  State  r.oard  uf  Health." 

l')V  an  act  of  the  legislature,  approved  June  i").  is'.i.").  and  in  force 
Inly  1,  lSI)."i.  it  was  made  the  (lut\-  of  the  trtislees  (if  the  University  to  est;ib- 
lish  and  manage  "a  laboratory  in  connection  with  the  .'^tate  L'niversity  for 
the  propagation  of  pure  vaccine  virus,"  It  was  pruxided  in  the  .Act  that 
"the  State  I'.oard  of  Health  sh.all  exercise  super\isi(in  uf  the  methods  of 
propagation  and  certify  to  the  pm-ity  of  ibe  ]iniducls."  .\n  a])])niprialion 
of  $3000  was  made  to  establish  and  ni.iintain  the  laboratory.  Dr.  Thomas 
J.  Btirrill,  Professor  of  15otaii\  .uid  I  lurtictilture  and  Dr.  Donal  Mcintosh, 
Professor  of  X'eterinary  Science,  both  Umk  an  active  interest  in  the  m;in;ige- 
ment  of  the  ])lant. 

On  Oct.  ;!(!.  lS9ii,  Dr.  Edgar  1'.  Cook  reported  the  results  of  an  inspec- 
tion of  the  plant  to  the  State  Board  (if  lie.ilih.     It  read  in  ];arl  as  fdllnws: 

"We  indorse  the  following  excerpt  taken  from  a  recent  ciroular  letter  sent 
out  from  the  laboratory;  'The  laboratory,  an  isolated  building  to  be  used  for  no 
other  purpose,  has  been  provided  and  properly  equipped  to  attain  the  purposes 
of  the  law.  The  most  careful  attention  has  been  given  to  everything  which  can 
facilitate  freedom  from  contamination.  The  ceilings,  walls  and  floors  of  the 
operating  and  animal  rooius  are  so  fluished   that  they  can  be  frequently   washed 


SoO  I'riii.ic  m;.\i.Tii  ahm  ixistnation 

Willi  liujc  ;iii(l  scruhliiug  l)i'ush  iuul  otherwise  thoroughly  (lisiiit'ecteil.  A  crematory 
is  provided  for  burning  all  litter  and  other  organic  matter.  .None  but  animals 
bred  by  the  University,  or  of  well  known  parentage,  and  selected  with  great 
care,  will  be  used.  Everything  is  being  done  to  secure  bacterial  cleanliness  and 
insure  the  preservation  of  the  virus   in  a  state  of  reliable  purity. 

"Careful  examination  verified  the  correctness  of  the  above  statement.  The 
building  had  been  constructed  for  and  used  by  the  Veterinary  Department.  Some 
necessary  changes  were  made  in  its  arrangements  adapting  it  very  well  to  the 
purpose  of  a  vaccine  laboratory.  It  is  very  pleasantly  located  in  a  grove  nearly 
equi-distant  from  the  I'niversity  Hall  and  the  buildings  of  the  University  Experi- 
mental Farm.  In  its  exterior  it  has  the  appearance  of  a  neat  cottage  being  ex- 
tended in  otie  of  its  dimensions  by  that  part  of  the  structure  that  is  the  tempo- 
rary home  of  the  juvenile  bovines  in  whose  living  laboratory  is  produced  an 
animal  immunizing  agent — vaccine  virus.  The  grounds,  like  all  others  about 
the  University,  are  neatly  kept.  The  interior  of  the  building  is  pleasing.  It  is 
a  model  of  neatness:  with  office,  operating  room  and  room  adjoining,  equipped 
with  modern  facilities  for  sterilizin.t;,  etc.  The  rooms  for  the  heifers — we  can 
not  call  them  stalls — are  convenient,  well  lighted  and  ventilated.  The  degree 
of  cleanliness  of  all  approaching  very  nearly  that  of  one  of  our  modern  hospitals. 
The  heifers  selected  are  the  best  obtainable,  and  their  care  and  treatment  the 
best  possible. 

"Their  preparation  for  inoculation,  the  operation,  subsequent  care  and  pro- 
cess of  securing  and  preserving  the  lymph  are  as  aseptically  done  as  possible. 
We  only  need  to  add  that  Sec.  3  of  the  Act  establishing  the  Laboratory  reads: 
'That  the  product  of  the  Vaccine  Laboratory  shall  be  furnished  all  physicians  and 
health  officers  within  the  State  at  the  cost  of  propagation."  " 

.\p|iaretilly  the  wicciiU'  hil>iir:it(ir\  w  aN  j^ivcn  up  Minti  alter  this,  fur  there 
IS  HI)  furthet"  record  nf  it  in  the  miimles  of  the  I'.dard.  The  jnirchase  i.if 
smal'pn.x  vaccitie  is  noted  fnini  time  lo  time,  itiitii  in  1  !•".':>  it  was  itichided 
iti  the  sjiecificatidns  for  biolciyical  products  lu  be  purchased  under  contract 
and  disttihuted  free  of  charge. 

Diphtheria  antitoxin,  dating  from  ISiMI,  catiie  into  general  use  after 
18!)4.  In  IS'J.j  the  L'hicago  HeaUh  Deiiartment  jiroNided  stations  through- 
out the  city  where  it  could  he  ohtained  without  delaw  and  where  it  was  giveti 
free  of  charge  to  those  unaMe  to  pa\'. 

In  11)11.")  the  legislature  atuended  the  Act  of  IS^;  creating  a  Board  vi 
}leallh.  providing  that  "it  shall  he  the  duty  of  the  l'o;ird  of  Health  of  the 
State  of  Illinois  to  appoint  one  agent  in  the  count}-  seat  of  each  county  in  the 
State  who  shall  lia\e  for  (rslrihulioii  ;i  supph'  of  diphtheria  antitoxin,  certi- 
hed  to  hy  >aid  Itoarcl,  etc."  and  finllier  proviilin;;  for  the  sale  at  a  reasonable 
])rice  or  for  the  free  distribtttion  lo  ])oor  persons  on  certilicate  of  the  over- 
seers of  the  poor.  In  l!i()'.)  ;nitiloxin  was  given  free  to  all.  .Massachusetts 
was  the  on'y  state  up  to  this  time  which  distribuled  diphtheria  antitoxin  in 
this  manner. 

In  IDL),  tNphoiil  vaccine  and  silver  mtrate  weie  added  to  the  free  list 
to  In-  distributed  by  agents.  Smallpox  vaccine  in  IDl."),  Schick  test  material 
in  lIMii.  diphtheria  toxin-antitoxin  in  l!):^!  and  antirabic  vaccine  to  poor  per- 
sons in  l!lv;i.  came  in  turn. 


PUBLIC    HEALTH    ADM  I  XISTKATION  251 

Provision  for  the  free  treatment  of  jKior  persons  bitten  by  rabid  animals 
was  provided  for  as  early  as  UK),"),  when  the  legislature  passed  "an  act  to 
provide  for  the  treatment  and  care  of  poor  persons  afflicted  with  the  disease 
called  rabies."  It  was  necessary  for  >ucb  persons  tci  £;(i  to  a  hospital  with 
which  the  State  had  a  contract  for  the  administration  of  anti-ral)ic  material. 
the  long  trip  often  being  inconvenient  to  the  patient  as  well  as  expensive  to 
the  county  in  railroad  fare  and  maintainence  (d"  patient  and  attendant.  In 
1923  the  distribution  of  the  vaccine  to  the  local  i)hysician  who  could  admin- 
ister it  to  the  patient  at  home  was  inaut;urated  and  proved  a  great  saving  in 
expense  to  all  concerned. 

In  l!il!i  the  biological  and  research  laboratories  were  established  to 
manufacture  the  various  biological  products  which  heretofore  had  been  pur- 
chased under  contract  and  to  investigate  problems  pertaining  to  public  health 
work.  Because  of  the  lack  of  proper  personnel  and  quarters,  this  idea  has 
never  been  fully  realized. 

In  1!)20  quarters  were  tibtained  in  the  plant  of  the  former  hog  cholera 
serum  laboratory  five  miles  from  the  Stale  House  and  i)reparations  made 
for  the  manufacture  of  typhoid  vaccine  and  some  other  products.  It  was 
later  decided  however,  to  continue  the  purchase  of  these  materials.  The 
(juarters  there  were  used  for  a  few  years  for  W'asserniann  work.  ]ire]iara- 
tion  of  mailing  containers,  housing  of  animals  and  the  like,  but  later 
gi\en  up  because  of  inaccessibility. 

RESE.\RCH  work:  The  necessity  for  research  has  always  1)ecn  recog- 
nized. In  the  Annual  Report  uf  llu  Stati-  Baanl  of  Health  in  I'.KIO  the 
following  statement  is  made. 

"It  is  the  belief  of  tlie  Board  that,  had  the  laboratory  not  accomplished,  in 
its  two  years  existence,  anything  more  than  it  has  done  in  placing  aerial  disin- 
fection upon  a  sound  and  scientific  basis,  tlie  time  and  money  devoted  to  it  would 
have  been  well  spent." 

Research  activities  have  been  somewhat  limited  due  to  inade(iuate 
personnel  and  quarters.  It  has  been  necessary  to  use  the  personnel  of  the 
biological  and  research  laboratories  largeK-  for  routine  diagnostic  work, 
devoting  wliat  little  time  was  available  lo  iirolilems  that  could  lie  jiicked 
u]i  and  dropped  according  to  pressure  of  routine.  In  fact,  a  stud)'  made 
in  V.m  by  the  Carnegie  Foundation  on  research  facilities  of  the  State  of 
Illinois  recomtnended  that  all  research  acti\ities  of  the  State  be  confined  to 
the  State  University,  while  other  branches  of  the  State  government  devote 
themselves  strictly  to  routine  activities.  This  of  course,  was  impossible  to 
put  into  practice. 


'dij'/i  I'UIiLIC    lil'.ALTII    ADMIMSTKATIOX 

The  first  result  of  research  was  pubhshed  in  1920,  since  which   time 
eighteen  other  contributions  have  appeared,  as  shown  by  the  following  list: 

IXVKSTKIATIOXS    CoNDt'CTEl)    IX    THE    BlOLOGICAL    AND    ReSEAECH 

Laboratories. 

1SI20.       The    Sachs-Georgi    Test    for   Syphilis. 

Thomas   O.    HiiH    and    Kva    E.    Faught. 
Journal    of    Immunology,    Xov,    1920,    J,    521-527. 
This    was   an   attempt    to    make    more   workable    one    of    the    ea^'ly    preeipitation 
tests  for  syphilis. 
1U22.       Anthrax    in    Shaving   Brushes. 
Thomas  C.  Hull. 
Fifth   Annual    Report. 

Illinois    Department    of    I'ublic    Health,    p.    inO-191. 
Ten    cases   of   human   anthrax    led    to   a   study    •<{   shaving    brushes.      AVhile    the 
more    expensive     brushes    showed    no    contamination,     many     cheap     brushes 
were   found   to   be  badly  contaminated. 

1922.  A    Study   of   the    Typhoid    Epidemic   at    Kewanee,    111. 

Thomas   G.    Hull    and   Kirby    Henkes. 
Illinoi.s   Health    Xews,    1!]22,   S,    196-199. 
Twenty-five   cases   of   typhoid    fever  on   one    milk    route   led   to    the   detection    of 
a  carrier  on    the   farm. 

1923.  Preserved  Cultures   in  the  Widal    Test. 

Thomas  C!.  Hull  and  Hugh  Cassiday. 
Abstracts   of   Bacteriology,    1923,   7,    3. 
A    report    presented    to    the    Society    of    American    Bacteriologists    to    the    effect 
that    dead   cultures    were    not   as    reliable    as    living    typhoid    cultures    in    the 
performance  of   the   Widal   test. 
1923.       The    Widal    Test    in    Tuberculosis. 

Thomas   G.    Hull   and    Kirby    Henkes. 
Abstracts  of  Bacteriology,    1923,   T,    28. 
.\    report    presented    to    the    Society    of    American    Bacteriologists    that    persons 
afflicted    with    tuberculosis    sometimes    gave    peculiar    and    characteristic    re- 
actions  with    the  Widal    test. 
1923.       Intracutaneous   Reactions  in  Pertussis. 

Thomas  G.   Hull  and  Ralph   W.   Nauss, 

Journal   of  American   Medical   Association,   June  23,    1923,  SO,   1S40-1S41. 
The    intracutaneous  injection  of  a  dead  culture   of  pertussis  bacilli   was   found 
unreliable    for   the  early  diagnosis   of  whooping  cough. 

1923.  Agglutination    of    the    Flexner    Dysentery    Bacillus    by    the    Blood    Serum     of 

Tuberculous  Persons. 

Thomas   G.   Hull   and   Kirby    Henkes. 

American   Review   of   Tuberculosis,    Xov.    1923,   S,   272-277. 
Persons  in  the  incipient  stage  of  tuberculosis,   apparently  carry   in   their  blood 
stream  a  substance  capable  of  agglutinating   the   Flexner   dysentery   bacillus 
while  persons  in   the  advanced  stage  of  the   disease   do  not. 
1921.       Another    Milk-Hc.riu-    Typhcul    Kpidemic, 
Thomas  G.    Hull. 

Illinois  lleallh    .News,    .luly    1924,    in,    1117-201). 
A    lyphoid   outbreak    at    Litchlidd.    111.,    where    two   carriers   were    found    on    the 
dairy   farm. 

1924.  The  Control  of  the   Public   Health   Laboratory. 

J.    J.    McShane   and   Thomas   Ci.    Hull. 

American    Journal    of    Public    Health,    Xov.    1924,    r.},    950-953. 
The  report  of  a   committee  appointed  by   the  advisory   board   to  study  methods 
emi)loyed  in  other  states  of  co-operating  with  or  controlling  private  labora- 
tories doing  public   health   work. 


PUBLIC    HEALTH    ADM  I  XISTRATION  2i)3 

1924.  The    Effect    of   Heat    on    the    Staining   Properties    of   the    Tubercle    Baoillvis. 

Thomas    G.    Hull,    Kirby   Henkes   and    Luella    Fry. 

Journal  of  Laboratory  and  Clinical  Medicine,  Nov.   1924,  10,  150-153. 
Steam  pressure  at  15  pounds  for  S  hours  or  dry  heat  at  150°  for  one   hour  and 
forty  ininutes  did  not  cause  the  tubercle  bacillus  to  lose  its  acid-fast   stain- 
ing properties. 

1925.  Agglutination   Reactions   of  the   Paratyphoid-Dysentery   Group    in    Tuberculosis. 

Thomas   G.  Hull,   Kirby   Henkes  and  Hugh  Cassiday. 
American    Review    of    Tuberculosis,    Mai'ch    1925,    11,    7S-S4. 
Agglutination   reactions   with    blood   serum    from    persons    in   various    stages   of 
tuberculosis    were     obtained    with     certain     members     of    the    paratyphoid — 
dysentery  group. 

1925.  The    Schick   Test   and   Scarlet   Fever. 

Thomas  G.   Hull. 

Journal   of    L.aboratory   and   Clinical    Medicine,    Dec.    1925,    II,    260,    2ril. 
An   attack  of  scarlet  fever  appears   to   destroy   the   diphtheria   antitoxin    in    thi- 
blood   streani,   causing  the   Schick   test   to   become   positive. 
192(i.      Laboratory   Differentiation   of   Smallpox   and   Chicktnpox. 
Thomas  G.  Hull  and  Ralph  W.   Nauss. 

American   Journal    of   Public   Health.    Feb.    1926,   1«,   101-106. 
Smallpox   may   be   differentiated  from    chickenpox   by   the   intracutaneous    in.iec- 
tion    of   iininune    rabbits   with    serum    from   the    pustule    of   the    patient. 

1926.  The  Widal  Test  as  carried  out    in    Public   Health    Laboratories. 

Thomas  G.   Hull. 

American    Journal    of    Public    Health.    Sept.    i;i26,    16,    901-905. 
The    Widal    test    needs    standardizing    according    to    a    study    of    methods    used 
in    53    public    health    laboratories. 

1926.  The    Control    of   Private    Laboratories. 

Thomas   G.    Hull. 

The   Nation's   Health,   Dec.    1926,   s,    SII9-10. 
A   discussion   of  certifying   private    laboratories    doing    public    health    work. 

1927.  Undulant   Fever   as  a   Public   Health   Problem. 

Thomas   G.    Hull   and   Luther   A.    Black. 

Journal  ol  the  American  Medical  Association,  Feb.   12,  1927,  88,  463-464. 
Among    70    serums    tested    with    bacillus    abortus    antigen,    5    reacted    positively 
in  high  dilutions,  indicating  infection  with  bacillus  abortus. 
1927.       Twenty-six   Thou.sand   Kahn    tests   compared    with    the    Wassermann. 
Thomas   G.   Hull. 

Journal  of  the  American   Medical   ^Association,   June   11.    1927,  N8,   1S65-1S66. 
The    two    tests    gave    relative    agreement    in    about    9S     percent    of    instances. 
Treated   cases    of   syphilis' gave    the    inost    discrepancies. 
1927.       Seasonal    Prevalence    and    Control    of    Rabies. 
Thomas  G.   Hull. 

The  Nation's  Health,   June   1927,  !>,   21-24. 
Rabies    is    on    the    increase    throughout    many    portions    of    the    United    States. 
March    is    the    montli    of    greatest    prevalence    in    many    communities. 

I>i<ifiiiiisf ic  Ldhiinif'iri/. 

In  August  uf  liJUl.  Dr.  James  .\.  I'.gan,  secretary  of  the  State  Board 
of  Health  was  successful  in  aci|uirino  funds  originally  intended  for  sani- 
tary investigations  and  using  thcin  for  opening  a  laboratory.  This  was 
located  in  the  Odd  Fellows'  Building  in  Springtield  and  Mr.  W.  H.  Ht)yt 
a  medical  student  was  put  in  charge.  Specimens  for  the  diagnosis  of  di]ih- 
iheria,   typhdid,   tuberculosis   and   malaria    were   examined. 


'■ioi  l'l,l!l.|i     HEALTH   ADMINISTRATION" 

In  l'.)()o,  an  appro]jriation  of  $1,200  was  secured  from  the  General 
Assembly  for  the  services  of  a  bacteriologist  and  $1,800  per  annum  for  "ex- 
penses of  laboratory  for  investigation  of  diseases." 

The  one  room  in  the  Ofld  Fellows'  building  soon  became  inadequate 
to  house  the  rapidly  developing  work  and  on  Nov.  15,  1906  quarters  were 
secured  in  an  apartment  house  located  within  (jiie  block  of  the  State  House 
and  directly  opposite  the  site  of  the  Supreme  Court  building.  Here  a 
six  room  apartment  was  shared  with  the  bureau  of  vital  statistics. 

'i'hc  next  change  in  location  was  made  to  the  State  House  where  the 
laboratory  remained  for  a  number  of  years  in  a  small  room  on  the  second 
floor.  In  1917  it  was  moved  to  the  sixth  floor  where  it  shared  quarters 
with  the  division  of  .sanitary  engineering  which  were  suppo.sed  "to  be  ade- 
quate for  many  years".  So^  rapid  was  the  increase  of  laboratory  examina- 
tions however,  that  the  space  soon  became  cramficd  and  an  attempt  was 
made  to  relieve  congestion  by  moving  some  of  the  work  to  the  former 
plant  of  the  hog  cholera  serum  laboratory  five  miles  north  of  the  State 
House.  This  division  of  work  did  not  prove  practical  and  gradually  the 
workers  were  re-called  and  the  cjuarters  at  the  serum  laboratory  were  given 
up  in  1925.  Additional  space  on  the  sixth  floor  of  the  State  Hou.se  was 
acquired  in  \'.)ii<>,  which  made  jjossible  the  neces.sary  expansion  of  activities. 

In  the  2'-i  years  that  the  laboratory  has  existed,  ten  dififerent  individ- 
uals liave  been  in  charge  as  follows: 

W.  H.  Hoyt   1904-  5 

H.  C.  fJlankenmeyer,  M.  D 19f)5-  7 

Wallf^r  a.  Bain,  M.  D 1907-  9 

Flint   MoiKlurant,  M.  D 190!) 

W.  a.  Crowley,  M,  U 1909-10 

N.   E.  WagBon,  M.  D ...1910 

W.  H.  HolmeH.  M.  D 1910-11 

Geo.  F.  Sorgalz,  M.  D 1911-18 

.Martin   Uijpray.  M.  S 191K-19 

TboniaH  G.  Hull.  I'h.  U 1920-to  date 

111  l!»i)l  when  the  laboratory  was  first  started  fjiijy  IT!  examinations 
were  made  during  the  fall  months,  covering  dijjhtheria  cultures,  sputum 
examinations  for  tubercle  bacilli,  blood  examination  for  malaria  parasites 
and  Widal  tests  for  typhoid  fever.  The  volume  of  work  increased  very 
markedly  during  the  next  dozen  years,  especially  in  sputum  examinations 
l)Ut  with  almost  no  increase  in  scope.  Unfortunately  no  records  are  avail- 
able for  the  years  I90H  and  \'.)W). 

In  1917,  came  the  war  with  its  venereal  disease  program  and  free 
Wassermann  tests  and  gonorrhea  examinations,  and  general  em])hasis  on 
all  things  of  a  laboratory  nature.  With  the  return  of  physicians  from 
military  service  the  demands  on  the  laboratory  for  all  kinds  of  work  in- 


A  section  of  the  main  laboratory  at  Springfield  where  general  diagnostic 
service  is  done  free  for  the  citizens  of  Illinois  (1924t. 


2-)(; 


iTKi.u     iii;ai.iii    AHM  I  XISI  KATKIN 


creased  markedly,  lu  V.y^O  routine  exaiiiinatidns  for  all  contagious  diseases 
for  which  laboratory  tests  were  availalile  wen-  Ijeing  made,  including  the 
complement  tixation  tests  for  gonorrhea  and  luhcrculosis. 

In  \[>'iij.  after  considerable  experimentation,  the  Kahn  ])reci])itation 
test  for  s\  philis  was  adopted  as  a  routine  in  addition  to  the  Wassermann 
test.  In  June  1927,  the  Wassermann  test  was  dropped  as  a  routine  pro- 
cedure ;  except  where  there  was  a  special  request  for  it.  It  was  soon 
found  that  there  were  no  such  re(|uests. 

The  interest  of  veterinarians  in  j)ulilic  health  laljoratory  work  had  been 
confined  mainly  to  rabies  for  some  years.  In  1924  the  contagiousness 
of  bacillus  abortus  of  cattle  for  man  was  sliown  in  several  human  cases 
in  Illinois.  A  demand  u])on  the  laboratory  for  routine  testing  of  cattle 
for  contagious  abortion  was  immediately  made  by  veterinarians.  Since  the 
Department  had  neither  the  facilities  nor  personnel  for  this  additional  bur- 
den, only  a  small  number  of  blood  specimens  from  cattle  were  examined. 
In  all  matters  relating  to  animal  diseases,  the  closest  co-operation  was 
maintained  with  the  division  of  animal  pathology  at  the  University  of  Illi- 
nois. 

*  Table  24. 


Diagnostic 

L.-\BORATC>RY- 

—Total  Examin.\tions,  1904-27. 

Main  laboratory 
Springfield. 

Branch 
laboratories. 

Social  hygiene. 

Total.  ■ 

171 
1.425 
2.370 

171 

Iil05 

1,425 

2,370 

111  - 

3,275 

?? 

1909.                                               1                       ■'? 
1909- 10.                                          1                   4.024 

?? 

4,024 

4,037 

1911-12 
1912-13 
1013  14 
1014-lS 
1915  Ifi 

4,249 
4,442 
4,222 
4,611 
7.579 
6.013 
10.499 
12.003 
31.494 
52.008 
83.630 
82.840 
84,104 
78,311 
99,259 
134,200 

4,219 

4,222 

1,409 
2.429 
2,399 
3.05S 
3,412 
7,691 
8,442 
4,576 
5,520 
4,611 
9,037 
5,845 

8.988 

8,482 

'          ' 

12,898 

I'.llv    VI 
19l!l  '211 
,,,.„  -Ji 

i!i:i  ;- 

19L':;  :•! 
1921  -'.■) 
192.-,  21. 
192fi  27 

4,628 
84,749 
20.205 
27,128 
27.893 
79,736 
93,726 
52.725 
84,749 

15.061 
39.543 
79.904 
119,200 
115.309 
169.360 
176,648 
161,021 
221,794 

I'UBLIC    HMALTII    ADMINISTRATION  V.)i 

TliL'  lollDwinsj;  is  a  list  of  exaniinalions  made  by  the  diagnostic  laboratory 
showing  the  }'car   when  they   were  begun: 

Diphtheria   cultures    1904  Dysentery   cultures    1918 

Sputum    for    tubercle    bacilli 1904  Meningococcus   cultures    ....    1918 

Widal    tests    1904  Pneumococcus    typing    1918 

Malaria  examinations    1904  Tuberculosis   fixation    tests 1920 

Kabies    examinations    1909  Gonococcus  fixation  tests 1920 

Wassermann  test.s — blood  and  spin-  Colloidal  Gold  tests.  ...    1920 

al  fiuid    1:117  Diphtheria    virulency    tests 1920 

Pus    for    gonococci 1917  Kahn  precipitation  tests 1926 

Treponema    pallidum    Iill7  Vincents'   angina    1927 

Typhoid    cultures    feces,    urine    and 

blood     1918 

Occasional  examinations  have  been  made  since  the  period  lltlT  to 
I'i-'o  of  specimens  which  have  not  been  numerous  enough  to  list  as  "routine", 
but  classed  under  miscellaneous,  including  examinations  for  anthrax,  chan- 
croid, glanders,  streptococcus,  sore  throat.  \'incents'  angina,  alscj  the  Weil- 
Felix  test  for  typhus  fever,  blood  cultures,  oyster  examinations,  food  poi- 
.soning  investigation,  etc. 

Previous  to  1920  a  certain  number  of  routine  urine  analyses  was  done 
as  were  also  blood  counts,  together  with  an  occasional  tissite  examination. 
Since  that  time  these  activities  have  ]jeen  confined  to  instances  where  a 
communicable  disease  was  involved,  leaving  the  routine  specimens  to  clin- 
ical laboratories. 

Previous  to  lii'iv'  very  few  milk  examinations  were  made.  In  that 
year  in  conjunciimi  with  the  milk  campaign,  bacterial  plate  counts  and  sefli- 
ment  tests  were  made  in  several  cities  and  since  then  milk  specimens  have 
been  examined  at  irregular  intervals  in  considerable  numbers,  culminating  in 
the  use  of  a  mobile  milk  laboratory  in  1927  for  field  work. 

BR.\NCH  LABOR.ATORiEs:  In  1915.  it  .seemed  advisable  to  establish  branch 
laboratories  to  improve  the  service,  especially  in  diphtheria  work.  Accord- 
ingly, contracts  were  drawn  up  with  the  Burdick-Abel  Laboratory  in  Chi- 
cago and  with  Dr.  W.  H.  (iilmore  in  Mt.  Vernon,  to  examine  diphtheria 
cultures  for  diagnosis  ,it  the  rale  of  50  cents  each.  Cultures  for  quarantine 
release  or  for  sur\ry  \\(irk  as  in  schools,  were  sent  to  Springfield.  Similar 
contracts  were  later  m.ule  with  other  laboratories  to  includi;  not  only  diph- 
theria diagnosis  but  al.-o  Widal  tests,  malaria  and  gonorrhea  specimens. 
Because  of  lack  of  funds  the  scojie  of  the  branch  laboratories  was  confined 
to  diphtheria  diagnosis.  Later  in  l'.i2-.',  instead  of  paying  for  each  culture 
examined  most  of  the  l;il)oraliirics  were  paid  a  stated  .sum  each  month  on  the 
basis  of  the  ainoinil  of   wt>rk   |)re\iiiuslv  dcjne. 

In  l!»2.j  a  definile  change  in  br.anch  laboratory  policv  occurred  when 
the    Palestine    l.abor.-itory.    connecte<l    with    the    C'rawfnnl    Couiit\-     Health 


258  I'UBLIC    IlKALTU    ADMI  NISTKATIO.X 

Unit  and  the  southern  branch  hibdratory  at  C'arl)iintlale  were  openeih  All 
procedures  connected  with  public  he.dlh  work  were  provided  for.  The 
Palestine  laborator)-.  under  Dr.  J.  A.  llkeinire,  was  later  discontinued  when 
the  Crawford  Count_v  Health  I'uit  was  given  U]).  The  t'arbonda'e  labora- 
tory esiabli.shed  in  an  emers^jency  was  made  permanent  to  till  the  demand 
for  service  as  the  result  of  work  done  by  the  field  laboratorv  sent  to  south- 
ern Illinois  for  tornado  relief.  When  the  rest  of  the  Department  activitic'^ 
were  discontinui-d  the  laboratc  ry  remained  as  the  southern  branch. 

In  I!)'.';  airangemcnts  were  completed  for  a  branch  laboratory  in  L'hi- 
cago  at  the  Slate  Research  1  lospiial  with  Dr.  Lloyd  .Vrnold  in  charge. 
While  the  laboratory  is  indei)eadent  of  the  medical  school  and  hospital, 
certain   material    from   the   lal)oratory   will   be  used    for  teaching  purposes. 

Following  are  tlie  branch  laboratories  which  the  IJepartnient  has  main- 
tained since  1915: 

Diphtheria   Diagnostic  Ladoratories. 

Chicago    Theodore  C.  Abel.   M.  D..  7  W.  Madison  St 1915-1927 

Mt.   Vernon    W.   H.   Gilmore iril5-1922 

Urbana    V.   W.   Tanner,   Ph.D.,   University  ot   Illinois l!)l6-to  date 

Galesburg    S.  G.  Winter,  M.  S.,  Galesburg  National  Bk.  Bldg. .  .  .llUC-to  date 

Rockford    W.   H.   Cunningham,   M.    D 1917-li)lS 

Moline    Maude  Vollmer,    M.  D.,    Lutheran   Hospital 191S-to  date 

Ottawa    R.   T.  Pettit,   M.  D.,   Illinois  Valley  Laboratory 1920-to  date 

East  St.   Louis Karl    Brennan,   M.  D.,   City  Health   Department 1922-to  date 

Decatur    Decatur  &  Macon  Co.  Hosp.,  B.  S.  Shackford,  M.  D. ..  1924-1925 

('.    R.    Smith.    M.  D 192.5-to  date 

Kankakee    -t.    Mary's    Hospital 192T-to   date 

Branch    Laboratories — All   Examinations. 

Palestine    Crawford  County  Health  Unit,  ,).  A.   n<emire,  M.  1 ). .  .U.i2.i-192li 

CarbonJale    Holden  Hospital,   Eva   Taught 192,5-to  date 

Chicago    Research   Hospital,    Lloyd   Arnold,    M.  U 1927^ 

FIELD  LAi!oK.\roRV  WORK:  The  field  laboratory  was  instituted  to  satisfy 
the  demand  for  laboratory  service  during  epidemics  in  comniunities  where 
no  local  laborator\-  existed  and  where  it  was  found  inconvcu'ent  or  impos- 
sible to  send  s])ecimens  a  distance  to  the  main  laboratorv. 

In  \U\'>,  a  chest  was  built  combining  the  minimum  necessities  for  mak- 
ing diphtheria,  txphoid,  and  meningitis  cultures.  Several  trips  each  \ear 
were  made  with  this  eciuipment  with  very  distinct  advantage.  Not  onlv 
were  tyjilioid.  diphtheria  and  meningitis  epidemics  solved,  but  also  other 
work  such  as  glanders  and  venereal  disease  diagnosis,  milk  bacteriology  and 
general  kdioratorv  work  taken  care  of.  Among  the  towns  visited  were 
Litchfield.  .\una.  C'arbondale.  Peoria,  Rock  Island,  Rockford,  Kev^-anee, 
Marshall,  Taylorville,  Belleville,  East  St.  Louis,  Granite  City-,  Streator. 
Belvidere  and  Galena. 


Equipment  and  personnel  for  setting  up  a  field  diagnostic  laboratory  are 
ready  at  all  times  to  respond  to  emersency  calls.  The  picture  shows 
the  Hold  unit  about  to  be  off  from  the  fapilol  Huildins;  to  Rook  Island 
in  litl':;. 


2(i0  I'l'iii.ic  iii:ai,tii  Ai)Mixisri;A  iihn 

An  interesting  trip  was  made  in  IH".':i  in  ]\(k]<  Islanrl.  A  fi-w  days  be- 
fore Christmas  a  telephone  call  |-e(|iiesied  urgent  help  in  eontrnUinij  a 
diphtheria  outbreak.  While  the  branch  laboratory  \\a>^  available  at  .Moline. 
supplies  for  several  thousand  cultures  were  not  at  hand  nor  could  they  be 
shipped  b\-  train  because  of  the  tremendous  congestion  of  Chrislmas  i)ack- 
ages  in  both  ])osi  office  and  express  office.  In  but  a  few  hours  culture  media 
for  the  entire  work  was  ready  and  loaded  into  the  laboratory  car.  P.y  driv- 
ing all  night  two  l.iactericlogists  with  necessary  supplies  and  equipment  were 
on  the  scene  the  next  morning. 

The  tornado  of  li>v!-j  in  southern  Illinois  caused  an  acute  situation 
making  the  presence  of  laboratory  ser\ice  indispensable.  Equipment  suf- 
ficient to  take  care  of  any  emergency  that  might  arise  was  dis]-iatched  Ijy 
automobile  and  installed  in  the  I'dks'  C'lul)  at  Carbondale. 

Through  the  co-nperation  of  the  National  Guard,  the  laboratory  equip- 
ment of  the  IdSth  Medical  Regiment  was  pooled  with  that  of  the  State  De- 
partment of  I'ublic  Health  and  placed  at  the  disposal  of  the  Department. 
While  the  main  laboratory  was  maintained  at  the  Elks'  Club  ni  Carbondale, 
sufficient  technicians  were  a\ailable  from  the  National  Guard  to  establish 
sub-lal)oratories  in  the  various  emergency  hospitals  in  Alurphysboro,  West 
Frankfort  and  at  Ifolden  Hi  sjiital  in  Carljondale.  With  th'_'  closing  of  the 
emergency  hospitals  and  the  withdrawal  of  the  Natimial  (iuard,  the  labora- 
tory was  mo\'ed  from  the  Elks'  Club  tn  the  temporary  oftices  of  the  State 
Department  cd'  Public  Health  at  ■.'■-'■.! '  2  South  Idimiis  Street.  So  well  did 
this  laboratory  function  during  the  next  tew  months,  not  only  in  the  storm 
area  but  all  over  the  soinhern  part  of  the  State,  that  its  abandonment  was 
out  of  questiin.  Definite  arrangements  were  made  with  the  Holden  Hos- 
pital where  commodious  ijuarters  were  provided  and  the  southern  branch 
laboratory  was  thus  established. 

The  field  laboratory  equipment  was  angmentetl  from  time  to  time  to 
take  care  of  special  emergencies  s;i  that  it  eventually  consisted  of  more 
than  half  a  dozen  chests,  packed  ready  with  sterilizers,  incubator,  acetylene 
gas  tanks  for  burners  anrl  other  necessary  materials.  (Jne  o-,  ail  the  chests 
were  taken  according  to  the  n.ature  of  the  emergency  and  amoimt  of  equip- 
ment that  might  be   found  locally. 

The  milk  campaign  initiated  in  l!l"25  resulted  in  various  milk  sur\eys 
in  different  communities.  These  were  disci  iitinued  because  of  lack  of 
laboratory  personnel  and  funds  to  satisfy  the  demand.  The  campaign 
resulted  in  the  pa>sage  of  the  milk  pasteurization  law,  the  enforcement  of 
which  require<l  a  com[]lete  laboratory.  -Such  a  laboratory  has  been  installed 
in  an  ;iutomi  bile  bus.  with  a  milk  bacleriolooist  in  charge  and  is  now  ready 


PUBLIC    HEALTH    AD.M  I  X  LSTRATION  ^Gl 

to  Start  nut  un  a  tuur  of  jjasteurizatiun  plants.  Wliile  this  mobile  laboratnrv 
was  built  primaril}-  for  milk  work,  it  was  so  constructed  and  e(]ui])ped  that 
it  can  take  care  of  any  emergency  that  may  arise. 

Status  (if  Lahdiaiin II  Wark  ni  Illinois. 

The  activities  i^f  the  State  Department  of  Public  Health  are  so  closely 
interwoven  with  innumerable  other  agencies  that  it  is  difficult  to  disen- 
tangle the  relationships.  The  laboratories  of  the  State  Ilealth  Department 
are  by  no  means  the  only  ones  doing  laboratory  work  of  a  public  health 
nature.  X'arirus  municipalities  maintain  laboratories  while  hospital  and 
pri\ate  clinical  laboratories  do  a  large  amount  of  work. 

The  Chicago  health  department  established  the  first  public  health  diag- 
ni^stic  laboratory  in  the  State  and  the  second  in- the  countrv  in  IS\H.  Since 
that  time  eleven  other  cities  have  provided  for  lalmratory  work,  some  with 
technicians  on  a  full  time  basis,  some  part  time  and  some  by  contract 
with  clinical  laboratories.  I'-vanston  equipped  its  laboratory  in  1908,  El- 
gin in  l!)lv!.  Rockford  in   191.5  and  Oak  Park  in  191T. 

Following  is  a  list  of  cities  making  provision  for  laboratory  work : 

Chicago  he.ilth  department,  til'ty  wmker.s,  fiiU  time,  alwut  375,000  examinations 
in  1926. 

Rockford  healtli  department,  one  worker,  lull  time,  about  .S.500  examinations 
in  1926. 

Oak  Park  liealth  department,  one  worker,  full  time,  about  1,700  examination.? 
in  1926. 

Aurora  health  department,  one  worker,  full  time,  aliout  2,500  examinations  in 
1926. 

LaSalle,  Peru  and  Oglesby  Hygienic   Institute,   one  worker,   full   time. 

Elgin  health  department,  one  worker,  full  time. 

Evanston  health  department,  one  worker,  part  time,  about  2,000  examinations 
in  1926. 

Easti  St.  Louis  health  department,  one  worker,  part  time. 

Peoria  health  department,  one  worker,  part  time. 

Joliet  health  department,  contract  with  local  laboratories. 

Quincy  health  department,   contract  with   local   laboratory. 

Decatur  health  department,  contract  with  local  laboratory. 

The  modern  clinical  laboratory  dates  almost  from  the  same  time  that  the 
]iublic  health  laboratory  does.  In  lS!il  there  were  very  few  clinical  labora- 
tinies.  in  the  modern  sense  of  the  word,  in  existence  either  in  hospitals  or 
under  private  auspices.  The  (■(ihinibus  Lal)oratories  in  Chicago,  one  of  the 
oldest,  was  founded  in  1893.  .\  few  hospitals  had  labdratories,  but  their 
activities  were  apparently  not  numerous.  In  Is'.i-")  St.  John's  Hospital  in 
Springfield  employed  Dr.  L.  C.  Taylor  as  bacteriologist. 

At  the  present  time  there  are  clinical  laboratories  as  follows : 

Hospital   laboi'atorles — Chicago   52 

Hospital    laboratories — Downstate    72 

Clinical   laboratories — (private)    Chicago    53 

Clinical   laboratories — (private)    Down-State 13 


262  la'iu.ic  uicALTii  admi.xistkation' 

Mdsl  (if  tlu-  clinical  lalioratciries  arc  ]irc]iarc(l  tn  carry  out  many  (if  the 
procedures  of  a  public  health  nature,  such  as  milk,  water  and  communicable 
disease  control.  Because  of  the  competition  of  the  free  nmnicijial  and  State 
laboratories,  however,  there  are  a  good  many  instances  where  speciinens  re- 
ciuiring  more  elaborate  ])rocedure,  as  the  culture  of  stock  s])ecimens  for 
typhoid  and  even  the  Wassermann  test,  ;ire  not  attem])ted  by  the  clinical 
laboratorv  but  sent  to  the  nearest  public  health  laboratory  or  to  the  State 
laboratory. 

The  competition  of  municipal  and  state  lalioratoi'ies  ha>  been  the  basis 
of  much  critici.sui  b_\  many  clinical  lalioralory  workers.  The  controversy 
has  centered  largely  around  the  Wassermann  test.  In  l'.)','.')  the  Illinois 
Medical  i^aboratory  Association  attempted  to  turn  more  \\(irk  to  the  private 
l.'iboratoiy  by  passing  a  resolution  re(|uesting  the  Director  of  the  State  De- 
partment of  Public  Health  to  re(|uire  the  name  and  address  of  the  patient 
with  every  Wassermann  specimen  done  in  the  state  laboratory.  The  Director 
referred  the  matter  to  the  .^tate  Medical  Society  where  adverse  action  was 
taken  upon  it. 

'I  here  are  four  groups  into  which  lalioratories  in  Illinois  fall. 

1.  Clinical  laboratories  m.-iintaim  d  by  a  competent  clinical  pathologist  with  a 
rncdica!    dej;rce. 

2  Hospital  laljoratories,  either  in  charge  of  a  competent  clinical  pathologist  or, 
as  is  the  case  with  small  hospitals,  a  laboratory  technician  suijervised  by  a  physician. 

■',.  t'ublic  health  laboratories  either  in  charge  of  a  competent  pathologist,  bac- 
terioloErist  or  chemist,  or  a  laboratory  technician  supervised  by  a  medical  heal  h  officer. 

4.  Clinical  laboratories  outside  of  hospital.s  in  charge  of  technicians  which  have 
no  medical  supervision. 

Laboratories  falling  in  the  first  groui.)  are  at  present  eligible  for  approval 
by  the  .\merican  Medical  .\ssociation.  The  program  of  the  Illinois  State 
Department  of  Public  Health  includes  groups  one.  two  and  three.  The  two 
organizations,  however,  try  to  co-ordinate  their  activities  so  that  a  laboratory 
is  not  approved  by  one  which  does  not  meet  the  requirements  of  the  other. 

The  following  lal)or;itories  have  been  issued  certificates  of  a])proval  by 
both  the  .\merican  Medical  .\ssociation  and  the  State  Dejiartment  of  Public 
Health. 

ChicaKo  L.aboratory — Chicago. 

Lincoln-Gardner  Laboratory — Chicago. 

Medical  Research  Laboratory — Chicago. 

The  Murphy  Laboratories — Chicago. 

National  Pathological  Laboratories — Chicago. 

Dr.    Homer  K.    Xicoll's   Laboratory — Chicago. 

Quincy  Clinical  Laboratory — Quincy. 

Rockford  Hospital  Laboratory — Rockford. 

nockford   Laboratories  for  Medical  Research — Rockford. 


2Gi  PUHI.lt'    HEALTH    AD.MINIS'l'RATION 

ill  additiiin  t(i  the  ahdvc  list  tilt'  t'lilhiwiiig  lahoralnrics  havf  lifen  ccrti- 
fietl  for  certain  procedtires  by  the  State  Department  of  I'liMie  Health; 

Kiiekford   HL-alth   Dyiartnient    Laboratory — Rockford. 

Decatur  and  Macon  County   Hospital   Laboratory — Utcatui-. 

Lake  View  Hospital  Laboratory — Danville. 

Our  Saviors  Hospital  Laboratory — Jacksonville. 

Lutheran  Hospital   Laboratory — Moline. 

Klgin  Municipal   Laboratory — Klgin. 

Aurora  Municipal  Laboratory — Aurora. 

Brokaw  Hospital   Laboratory — Bloomington. 

Pre.scription  Shop  Laboratory — Joliet. 

Holden   Hospital    Laboratory — Carbondale. 

Illinois  Valley  Laboratory — Ottawa. 

St.  -Anthony's  Hospital  Laboratory — Rockford. 

St.  Mary's  Hospital  Laboratory — Kankakee. 

Methodist  Hospital  Laboratory — Peoria. 

St.  Francis  Hospital  Laboratory — Peoria. 

St.  .lolin's  Hospital  Laboratory — Springfield. 

In  lli'M.  the  State  Department  of  Public  Health  took  an  active  part  in 
the  formation  of  the  Illinois  Public  Health  Laboratory  Association.  The 
name  was  later  changed  to  the  Illinois  Medical  Laboratory  .Association  as 
being  more  descriptive,  but  the  objects  of  the  organization  remained  the 
same.  Dr.  Thomas  G.  Hull,  chief  of  the  diagnostic  laboratory,  served  as 
president  for  two  years  and  then  as  secretary. 

One  of  the  tibjects  was  to  reach  the  technician  isolated  in  a  laboratory 
in  a  small  cit\',  who  if  a  member  of  a  national  technical  society,  rarely 
obtained  the  opportunity  to  attend.  P^recjuent  meetings  in  different  ])arts 
of  the  State  were  intentled  to  interest  and  stimulate  these  technicians  to 
better  work. 

The  certilicatit)!!  of  laboratories  by  the  State  Department  of  Public 
Health  came  about  in  lU'iii  when  the  Illinois  Medical  Laboratory  Association 
passed  a  resolution  requesting  the  Director  of  the  State  Department  of 
Public  Health  to  issue  certificates  of  approval  to  laboratories  found  com- 
petent to  do  jnihlic  health  laboratory  work  after  proper  inspections  had  been 
made.  The  Director  agreed  tii  this  arrangement,  limiting  inspections  only 
to  lalicr.-itories  fr<im  whieli  re(|uests  hatl  been  receivetl.  Many  conferences 
were  held  with  the  committee  on  education  ;ind  hospitals  of  the  .\merican 
Medical  Association,  which  was  also  carrying  out  a  national  program  of 
certif_\in^  clinical  lal)oratories.  The  program  of  the  Department  of  Public 
Health  went  farther  than  that  of  the  .American  Medical  Association,  how- 
ever, ill  that  frecjuent  insi)ections  were  made,  "unknown"  specimens  for 
examinatlnii  submitted  and  reports  returned,  certain  biological  reagents  fur- 
nished and  the  advice  tjf  a  bacteriologist  offered  in  times  of  necessity.  The 
local  laboratory,  on  its  part,  agreed  to  use  only  approved  methods,  to  make 
annual  statistical  reports  to  the  Department  and  to  assist  in  certain  ways  in 
times  (jf  epidemic. 


PUBLIC    HEALTH   ADM  IN  ISTKATIOX  2(55 

Drv'isiox  OF  Hotel  and  Lodging  House  Inspection. 

The  inspections  of  lodging  houses,  taverns,  hotels  and  inns  began  in 
1899  as  a  result  of  a  special  law  enacted  in  that  year  for  the  purpose  of  pre- 
venting serious  overcrowding  and  gross  insanitation  in  the  poorer  hostelries 
operated  in  Chicago.  At  that  time  the  city  vv'as  growing  very  rapidly  and 
deplorable  conditions  existed  in  some  quarters  where  persons  of  small  means 
were  given  shelter  at  low  rates.  The  wnrk  ni  inspecting  these  places  was 
confined  to  Chicago  by  making  the  law  appl\-  only  to  cities  of  100, ()()()  or  more 
population. 

The  duties  and  responsibilities  of  the  lodging  house  inspectors  are  all 
specifically  enumerated  in  the  law  and  the  division  maintains  headquarters 
in  Chicago.  The  number  of  employees  and  the  money  provided  are  specified 
in  the  law.  The  work  is  associated  with  the  State  Department  of  Public 
Health  principally  because  the  law  puts  it  under  the  general  supervision  of 
the  Department. 

.\t  the  outset,  July,  1899,  two  inspectors  were  employed.  Homer  C. 
Fancher  was  designated  as  chief  and  paid  out  of  the  general  funds  granted 
to  the  State  Board  of  Health.  Air.  Fancher  was  succeeded  bv  Edward  J. 
Smejkal  in  December  of  1S99.  He  managed  to  get  a  staff  of  10  insjiectors 
at  work  during  1900  but  most  of  them  were  on  a  temporary  basis. 

In  19(11  an  appropriation  of  -$12,500  per  year  was  set  aside  for  the 
inspection  of  lodging  houses  and  from  that  time  on  the  service  was  known 
in  appropriatif)n  laws  as  '"supervision  and  inspection  of  lodging  houses" 
etc.  until  liU;  when  along  with  all  other  units  in  the  State  health  machinery 
it  was  designated  as  a  "division".  Mr.  .^mejk.il  was  succeeded  as  chief 
inspector  by  William  (i.  I.anb  in  the  fall  of  19(il  who  was  succeeded  in 
1904  by  J(jhn  W.  I'tesch.  George  Delvigne  began  as  chief  ins]iecti>r  on 
October  1.  191:)  and  continued  until  191T  when  the  position  of  chief  insjiec- 
tor  was  abolished  and  in  its  jilace,  as  the  head  of  the  division  of  lodging 
hijuse  inspection,  was  established  the  position  of  su]ierintendent  of  lodging 
house  inspection.  To  that  place  was  appointed  W.  W.  AlcCulloch.  In 
October  1923  he  was  succeeded  by  .\rch  Lewis  who  has  continued  to  date. 

The  work  of  this  division  has  changed  very  little  during  the  long  |)eriod 
of  its  existence  except  in  volume.  Funds  provided  for  carrying  the  scr\- 
ice  have  increased  from  $12,500  per  year  in  1901,  to  $35,G75  in  192;. 


:iUU 


I'Um.lC    IIKALTII    ADM  I. MS  I  RATION 


Earl  B.  Searcy 


DlNISION    111'     I'lT.l.lC     I  1  I;aI,I1I     1  XSllilC'IKiX. 

Ediicalii  11  ill  1k;i1i1i  matters  was  re.t;ar(lc<l  as  a  ftiiidaiiK'ntal  activity 
of  the  State  health  service  from  the  time  of  its  creation  and  every  executive 
officer  of  that  service  gave  to  it  as  iinuh  time  and  thought  as  possible.  The 
])iibhcatioii  and  ihstrihntion  of  circuhu's  was  a  fa- 
\orite  \va\'  i>f  handhiig  the  matter  from  the  outset 
and  ciiiitiinirs  to  lie  important. 

Ivhicatiiin  was  always  stressed  by  Ur.  Ranch 
as  one  of  the  most  important  resuks  of  his  survey 
of  the  State  during  the  middle  eighties.  He  also  dis- 
tributed millions  of  leaflets  on  smallixix  and  large 
numbers  on  other  diseases. 

Vhv  annual  rejiorts  of  the  Pioard  which  were 
issued  with  more  regularitv  than  almost  anything 
else  that  it  ever  undertook  were  prepared  with  a 
\iew  til  their  educational  \alue. 
I'rdiu  lime  til  time  attempts  were  made  to  publish  a  ]icnrdical  bulletin 
jirior  to  1110(1.  The  few  numbers  that  came  from  press  were  called  ,S"/(;/i' 
Alcdiciiir.  This  idea  was  revived  in  IIH):;  when  two  numbers,  the  March 
and  .\pril.  nf  a  monthlv  publication  called  the  "Biil- 
Icliii"  were  issued.  Ai^ain  it  dni]iped  out  of  the 
acti\ities  .:nly  to  be  re\ived  in  I'.ioii  on  a  permanent 
and  more  or  less  regular  basis.  I'rom  that  time  un- 
til Uecember  IHIS  a  number  cif  the  "Bulletin"  w;is 
published  for  everv  month  and  bound  by  years. 

Then  the  publication  succumbed  to  another 
lapse  and  was  revived  again  in  1915  under  the  title 
of  "Heal III  A'c<e.T".  From  that  time  until  li)2U  it 
was  issued  for  each  month  but  quite  irregularly 
at  times.      Beginnins'  with    lli"^M    and   cuntinuini;"  to 

^  "  .  Dr.  ttenry  B.  Hoim'inva\. 

date  Hcallli  News  has  i.-i-me    t  mm   press  and  been  i 

mailed  during  the  month  of  its  date  with  but  one  or  t\\ii  exceptions. 
Prior  to  lill."i  the  |iulilicatiiin  was  prepared  for  a  medical  audience 
and  dislributed  among  plnsiciaus  alnmst  exclusively.  Since  that  time  it  has 
been  pnpular  in  cbar.icter.  (  )ii  ihe  mailing  list  the  laymen  out-number 
physicians  and  iiiclmle  teachers,  farm  ;;il\isers.  meniliers  of  women's  chiljs, 
nurses,  sc  cial  workers,   lncal  nfficials,  etc. 


PUBLIC    HEALTH    ADM  I  X  ISTKATIOX 


■Itu 


All  ut  the  ];ul)licit\-  work  was  handled  directly  by  the  secretary  nr  his 
assistant  imtil  1!IK  when  an  item  providing  ^l.'-idO  fur  a  medical  editor 
appeared   in  the  api)r()priati(in   law.     (_)n   the  basis  of  that   fund  a  division 

of   public   health   instruction   was  created   and   con- 

sisted  of  o:ie  individual  in  the  person  cf  I'.arl  B. 
Searcy  who  was  a  newsjiaper  man  and  began  \\or\-. 
on  September  '.M,  I'.lK.  His  jolj  was  to  edit 
Health  Xcics  and  prepare  material  for  the  news- 
papers. 

Mr.  Searc\-  went  to  war  on  -\pril  l'^,  I  His  and 
Dr.  Henrv  B.  Ilemenwa\-  acted  as  editor  of  Health 
News  untd  Mr.  Searc\-  returned  on  .\\m\  'IX .  1!)19 
.After  the  brief  period  of  three  mi  nths  he  took  a 
six  months  lea\e  beginning-   lidv   1.  i:M!i  and  ne\er 

^  &    .'      .        •  Samuel  W    Kis'~iii_.  i 

chose  to  return.     He  was  succeeded  on  July  -!■>,  l!)li) 

by  Sanuiel  ^^'.  Kessinger  wdio  received  a  temporary  appointment.  As  a  re- 
sult of  civil  service  examinations,  B.  K.  Richardson  was  appointed  to  suc- 
ceed Mr.  Kessinger  on  December  1,  I'.c^O.  Mr.  Richardson  has  continue<l 
in  the  capacity  of  chief  of  the  division  to  date. 

The  division  staiT  has  never  been  large.  At  first  it  cjas!ste<l  of  one 
person  who  was  trained  to  do  jniblicitv  work.  Then  in  l!il!l  a  stenographer 
and  exhibit  helper  v^-ere  added.  Another  stenc:grai)lK'r  was  addc<l  in  l!l"23. 
In  i;i'^;  the  staff  consisted  of  these  four  members. 

Beginning  in  1!)H  the  work  done  by  the 
division  relieved  the  Directur  nxire  and  more 
!if  the  detailed  activities  inciilental  to  the  prep- 
aration of  publicity  material  and  at  the  same 
time  the  scope  of  the  publicity  service  was 
graduallv  increased. 

Thus  by  li)'.i7  the  division  had  the  resjjons- 
ibility  of  securing  and  preparing  for  the  printLT 
material  stiitable  for  publication  in  Health 
Xcics.  It  is  published  monthlv  and  usuall\- 
runs  'A2  pages  to  the  number. 

It  was  preparing  as  a  weekly  rdutinc  func- 
tion a  story  and  a  sheet  of  pointed  paragraphs 
for  the  newsjiapers  (if' the  ."^tate.     This  service 
B.  K.  iiiiiiarci.son.  bis    ciintiuued    >niinterrupted]\'    since     fanuarv 

1,    l!i-,'l. 
It    exercised    snp-er\ision    over   a   moiinn    pictiu'c   librar\-    in    which   are 
maintained  xmie  eighty  odd  films  un  health  subjects.      These  are  luaned   free 
throughout  the  .'-^laie.  and  are  found  very  useful  in  health  educational  work. 


'ids 


I'l'lil.lC    IIKAI.lll    AliM  I.MSI  KA'I'IO.V 


The  ili\isi(:r.  was  arraiiyint;'  prugraius  and  haiuUinj^r  jmbliciiv  for  spt-cial 
events  like  I  lealtli  riiinidtiou  Week,  diphtheria  eradication  and  other  cam- 
paigns: alscj  the  better  baby  conferences  at  the  State  fair.  In  addition 
it   managerl   the  mobile   (-■xhibil  c<inipnient   maintained   by   the    Department. 

I'^urthermore  the  di\ision  exercised  snpervisicjn  o\er  the  publication 
of  educational  pamphlets.  'I'hcse  have  been  issued  in  large  (|uantities,  cov- 
ering more  than  a  score  of  subjects.  It  also  acce])ted  responsibilit\-  for  edit- 
ing the  various  reports  of  the   Department. 

Division'  ok  Si)ci.\l  IfvciF.XK. 
There  is  but  little  doubt  that  the  division  of  social  hygiene  came  into 
existence  as  a  result  of  tlie  startling  figures  given  out  by  the  government 
showing  the  alarming  prt'valence  of  \enereal  diseases  among  recruits  mobil- 
ized for  military  duty  in  the  World  War. 
Records  reaching  the  Adjutant  General's  office 
at  Washington  showed  that  three  per  cent  of 
I  he  first  million  men  mobilized  had  a  venereal 
disease  when  they  reported  at  their  respective 
camps.  Those  from  some  of  the  states  showed 
an  even  higher  percentage.  It  was  a  part  of  a 
general  effort  to  control,  suppress  and  eradicate 
venereal  disease  that  the  division  was  created 
July  1.  1!US.  It  actual'y  began  to  function  on 
\n\cmber  1,  of  that  year  when  the  first  federal 
funds  became  available. 

\\  ith  a  subsidy   from  the  government  of 
■tci;, .•)():. .""lO  for  the  year  ending  June  30.  19  111, 
Dr.  r,  c  Ti\i.,i  the  second  year  allotment  howe\-er  was  condi- 

tioned upon  an  appropriation  by  the  State  legis- 
lature to  be  matched  dollar  for  dollar  with  an  equal  amount  of  federal  funds. 
The  Tjlst  General  Assembly  ajjpropriated  for  the  use 
ni  ihe  division  of  social  hygiene  the  sum  of  $lt)0.0()0 
for  twi)  yi-ars  ending  June  .30,  lilvJl.  This  was 
inalclud  ])y  an  all(.)lment  of  $.")(), 0(10  for  the  second 
\ear's  work  from  the  federal  go\-eniment,  so  that 
llu're  was  .available  for  the  \ear  ending  June  30, 
i:»v'o  ihc  xum  ('f  >t5lOO,0()O.UO.  The  work  of  the 
li\isioii  has  proceeded  along  lines  established  tlur- 
iiig  ihe  lirst  year  conforming  in  gcner.il  to  the 
\iiureal  disi'.ase  progr.im  suggested  b\  the  Inter- 
de|)arlnu'nlal  I-^ocial  ll\gieiU'  I'xiard,  which  was  cre- 
ated bv  act  of  coiiiiress. 


PUBLIC    HEALTH    AD.Ml  XISTRATIUX  'ibV 

Treatment  nf  Disease  Carriers. 

Duf  m  the  acct-ptfil  fact  thai  there  exists  a  lack  of  i)rni:ei-  inf(jrniati(in 
concerning  the  serious  character  of  the  comphcation  and  seque'lae  wrought  l)y 
venereal  disease  carriers,  an  endeavor  was  made  to  place  before  the  public 
facts  pertaining  to  these  diseases,  and  along  these  lines,  clinics  were  opened 
in  the  following  cities : 

Chicago — 2  Decatur 

East  St.   Louis  Springfield 

Rock  ford 

In  the  year  1!J".'()  there  were  in  addition  to  the  aljo\e  named  clinics 
the   following: 

Alton  Chicago  Heights  Rock  Island 

Cairo  Litchfield  Waukegan 

Carlin\ille  jMoline  West  Hammond 

Chicago — 5  Peoria 

The  following  year  clinics  were  in  operation  at  Princeton  and  (Juincy- 
Later  clinics  were  opened  at  DuQuoin  and  Robinson. 

Froiii  the  year  lil'.'l  it  has  been  the  policy  of  the  division  t(.)  operate 
clinics  in  such  a  manner  as  nut  to  pauperize  the  public  or  infringe  u])Oii 
the  legitimate  practice  of  any  ])hysician.  This  is  obviated  by  ha\ing  the 
endorsement  of  local  medical  societies  before  taking  action  upon  applica- 
tion of  city  or  county  oflicials  requesting  that  clinics  be  opened.  Clinics 
are  established  whenever  the  Department  is  asstireil  that  for  every  clollar 
of  State  funds  subsidized,  there  will  lie  (k'ulilc  the  amount  appropriated 
from  city, or  county  funds. 

Repressire  Measures. 

It  is  a  known  fact  that  in  order  to  prevent  the  sjjread  of  venereal  disease, 
it  is  necessary  to  render  non-infectious  the  carriers  of  the  disease.  In 
order  to  carry  out  such  a  program,  it  is  essential  to  have  the  coo]ieration 
of  city  and  county  officials.  In  order  to  acquaint  officials  of  the  respective 
communities  as  to  prevalence  of  these  diseases,  vice  investigations  ;ire 
made,  and  the  results  of  such  surveys  are  confidentiallv  given  them.  In 
a  number  of  instances,  the  city  oflicials  have  seen  fit  to  p;iss  local  ordinances 
which  deal  with  male  offenders  .is  well  as  pnisiilntt-s.  From  a  public 
health  viewpoint,  every  rednciion  of  the  amount  of  irregular  sexual  in- 
tercourse means  just  so  rnucli  le>s  exposure  to  veneri-al  disease.  Due  of 
the  main  methods  of  reducin;;  ihest-  exposures  is  the  |in'\entini;  of  pro- 
fessional prostitutes  and  loose  women  of  all  kinds  from  anv  opportunil)- 
to  do  business,  as  these  women  are  the  most  ])rolilic  carriers  of  venereal 
disease. 


2,(1  PUHLIC    HEALTH    ADMINISTRATION 

Eiliicdl  ion. 

Svpliilis,  i;<incinliea,  chancruicl,  ilic  chief  \fiu-n'al  diseases  are  caused 
by  germs  whicii  can  he  identified  through  means  of  the  microscope.  I'^or 
these  diseases  there'  is  a  definite  curative  treatment  which,  if  hegun  promiitly 
is  usually  successful.  The  most  serious  results  come  from  im]jroper  or 
delayed  treatment.  The  cnnncctiou  of  these  dangerous  communicable 
diseases  with  .^e.\ual  immorality  has  prevented  pro]jer  discussion  of  the 
means  of  pre\eniing  and  curing  them  and  has  delayed  the  building  up  of 
effective  prevention  and  treatment  in  the  interest  of  public  health. 

The  social  and  economic  loss  caused  b\-  the>e  diseases  mark  them  as 
one  cif  mankind's  greatest  scourges.  When  it  is  taken  into  consideration 
that  fre(|uentl}'  moi-e  cases  of  venereal  disease  are  reported  than  that  of 
measles,  it  may  gi\e  the  pulilic  a  general  idea  as  to  the  prevalence  of  venereal 
disease.  There  ha\<.'  lieen  reported  in  Illinois  from  ])hysicians  and  clinics, 
1!)4,8(1S  cases  of  venereal  disease  during  the  period  July  1,  I'JIS  to  July  1, 
lli?(i,  while  the  number  of  cases  treated  at  the  clinics  showed  a  stupendous 
total  of  oi'.i.fti;. 

The  number  of  lectures  given  during  this  ]ieriod  was  I. Sit.  The 
educational  measures  used  to  combat  these  diseases  are  carried  on  by  the 
Use  of  placards,  pamplilets.  motion  ]iictures,  exhibits  and  lectures. 

To  show  the  interest  manifeste<l  liy  soci.al  workers  and  others  inter- 
ested in  the  venereal  disease  prolileni,  there  was  held  in  Chicago  during 
March  l-'!-lS,  lit".''.',  a  \'enereal  Disease  Institute.  This  was  conducted 
under  the  auspices  of  the  I'nited  States  Public  Health  Service  and  the 
liiinois  Department  of  Public  I  Icalth.  The  attendance  was  over  one  thou- 
sand. 

The  audience  was  composed  (}f  re])resentatives  from  every  walk  in 
life  and  incluik  d  doctors,  nurses,  educators,  social  workers,  judges,  busi- 
ness nun,  mothers  of  families,  clearlv  showing  that  the  efforts  to  arouse 
interest    in   the   subject   of    venereal   disease   had   been    successful. 

(kncrally  this  subject  has  been  of  interest  only  to  doctors,  but  on  this 
occasion  the  lecturers  recognizing  th.at  a  general  know  kdi^e  of  the  medical 
side  of  veneral  disease  is  necessary  to  tlvse  who  would  lit;ht  it,  so  pre- 
sented the  subject   that   it   could  be  ,t;raspcd   by  all   in  attendance. 

(  )ne  of  the  best  fcitm-cs  of  the  program  was  the  series  of  noonday 
luncheons,  at  which  prunnnetU  ri'presentativ  es  of  the  various  agencies  In- 
tel esli'd  in  combating  vmereal  disease'.  ])resented  their  views  as  to  how  the 
work  could  best  be  carried  on.  The  e'hurch  press  and  various  social  wel- 
fare' org.ani/.atieins  were'  re'prese'ute'd.  anil  suygeslieins  vvere  made  and  cein- 
cliisioiis  reaclu'd  which  will  be  of  inestimable  value'  if  put  into  |iractice 
iu  the'  elille'rent  communilie'S. 


PUBLIC    HEALTH    ADM  I  X  ISTRATIOX  ■.'7  1 

A  Striking  tealurc  ui  the  Insiitutc  was  the  changed  attitude  of  the 
audience.  A  short  time  ago  it  was  iniimssihle  to  frankly  discuss  social 
diseases  and  allied  suhjeets  hetore  so  \aried  an  audience,  hut  those  present 
at  the  conference  showed  l)y  their  whole  attitude  that  the  time  has  come 
when  it  is  no  longer  necessar\-  to  \cil  the  matter  under  a  cloak  of  false 
UKjilesty  :  that  it  can  he  apiiroached   with  unalTecteilness  and  ease. 

The  Social  Hygiene  Bulletin  which  had  heen  puhlished  monthly  since 
Sei)tenil,er  1,  ID'.'O,  was  discontinued  after  the  June  issue  in  ]'■>''■'>  due  to 
decrease  of  appropriations  for  the  hienniuuL 

Two  very  important  bills  relating  to  venere;d  disease  were  passed  hv 
the  rtord  General  Assembly.  The  one  aiiprt>\'cd  jtme  'il.  l!)v!3  amends 
section  ~u  of  the  Criminal  Code  to  pro\ide  that  anv  one  who  keeps, 
leases,  or  patronizes  any  disorderly  hi  use  shall  lie  hned  ncjt  more  than 
■$200.00  or  imprisoned  not  more  than  one  \ear. 

The  other,  approyed  June  "27.  l!l".'.'l.  amends  section  1  of  the  Divorce 
Act  by  adding  as  a  ground  for  <li\i)rce  the  fact  that  one  spouse  has  infected 
the  other  with  a  communicable   \  enereal   disease. 

Sniiniuir//. 

The     following    chronology    is    given    for    the    purpose    of    presenting 
the  activities  rendered  by  the  diyisiiju  in  a  more  precise  manner: 
r.tlS.      l)i\ision  ci  social  hygiene  was  created  on  a  hfty-hfty  federal  subsidy 

basis. 
1IM'.>.      The  establishment  of   \ enereal  disease  clinics  at  various  parts  of  the 

.State  was  begun.     Six   were  established   during  this  year. 
lliv!o.     .\(l(liiional  venereal  disease  clinics  establidied   in   State,  sufficient  in 

number  to  bring  the  total  to  nineteen. 
lifl'i.     A    one   week   intensive   coiu'se    relating   to   social    hygiene    was    con- 
ducted in  Chicago.      Alore  than    l.ooo  persons  registered  as  being 
in  attendance  on  the  K'ctnres. 
lilS;!,      Stand.nrds    of    infecti\ity    in    reference    to    \enei'eal    diseases,    which 
were    created    by   a    special    committee    of    experts    at    the    re(|uest 
of   the    State    Director   of    I'ublic    I  U'altb    were    adopted    and    put 
into  effect. 
A  stringent   law    jiertaining  to  vice   v\as  enacted. 
The    "Social   Hygiene    Moiitlily"    publication    which    began    in    I'.f.'d 

was  discontinued  diu'ing  this  year. 
.\    bill    providing    for   the    acceptance   of    federal    aid    to    almost    the 
amount    of    .$1  l.iiiKi.uo    in    social    lugiene    service,    failed    to    nass 
the   legislature.     A   decrease  of   $i!S.O((0   from   the   last   ])receding 
appropriation  limited  the  activities  of  the  division  for  the  biennium. 


272  ruuLic  health  admixistratiox 

l9"2o.  Law  passed,  jiiiHiuliiig  Scctinn  .')"  of  the  Criminal  Code,  and  which 
is  directed  at  the  very  center  of  the  venereal  disease  evil.  Law 
provides  heavy  hnes  and  inipris'  nnient  for  patrons,  owners,  leas- 
ors,  proprietors  or  other  persons  directly  influencing  the  opera- 
lion  of  houses  or  quarters  for  prostitution.  If  enforced,  this 
will  reduce  very  greatly  the  possibility  of  venereal  disease  in- 
fections. This,  in  turn,  would  make  niore  and  more  unneces- 
sary a  large  number  of  clinics  for  treating  such  diseases. 
Standards  of  infeclivity.  relatixe  to  the  treatment  of  venerally  in- 
fected ])ersons,  worked  out  by  a  committee  consisting  of  Doc- 
tors W.  A.  Evans,  Herman  N.  Bundesen.  Louis  Schmidt.  C.  C. 
Pierce  and  others. 
Standards  of  infectivity  jiertaining  to  venereal  diseases  officially 
adopted  as  a  jKU-t  of  the  rules  mk\  regulations  of  the  Depart- 
ment. Standards  printed  in  pamphlet  form  and  available  to  phy- 
sicians, heallh  officers,  social  w<irkers,  lawyers  and  judges  of  the 
comis. 


PREVALENCE 

OE 

VENEREAL     DISEASE   IN    ILLimiS 

,SE        '.T.:^  CA5L5 

6665 

.9.');o^^i^^  9957 

SYPHILIS  ^^.^^^^^__  ,^r^A-, 

iKozi^l^^HHi  10.043 

12,715 

12.965 

15,159 

15.115 

I  17,727 


i9i6i9|BB^^^^Hl^HI^^  19.630 


30,442 


MEDICAL  PRACTICE  ACT. 

Instinctively  the  ])eople  look  to  their  state  government  lor  protection 
against  trands  of  all  kinds  and  especially  for  protection  against  quacks  and 
culls.  Unless  the  state  measures  up  to  its  responsibilities,  many  incompe- 
tents and  some  rascals,  as  well  as  the  trained  ethical  physicians  use  the  title 
"Doctor."  The  public,  unable  to  dicriniinate,  and  believing  all  are  using  the 
title  legally,  are  liable  to  fall  into  inconi])ctcnt  hands,  when  in  case  of  illness 
they  come  to  select  their  medical  advisor. 

The  ethical,  trained  physicians  of  Illinois,  recognizing  the  public  need 
for  this  protection,  and  being  ever  the  guardians  of  the  health  and  welfare 
of  the  ]ieople.  early  began  to  agitate  the  need  for  medical  practice  laws. 

The  Practice  Act  of  1817. 

The  Third  General  Assembly  of  the  Territory  of  Illinois,  elected  in  ISUi, 
met  at  Kaskaskia  on  December  2  and  adjourned  on  January  11,  isK.  .\ 
second  session  of  the  same  assemblv  began  December  1.  LSIT,  and  ended 
on  January  18,  1818.  It  was  but  a  few  years  before  that  an  Act  of  Congress 
dividing  Indiana  Territory  into  two  separate  govemments,  revived  the  name 
of  Illinois  which  bad  officially  disajjpeared  after  the  organization  of  ths 
Northwest  Territory  in  IISD,  and  only  five  years  previous  had  the  Territory 
Ix-en  given  actual  governmental  powers. 

The  House  of  Representatives  that  sat  at  Kaskaskia  in  the  Third  Clen- 
eral  .\ssembly  was  made  up  of  but  seven  members,  and  was  presided  over 
by  Dr.  George  Fisher,  a  physician  who  had  migrated  from  \'irginia  in  1800. 
This  was  the  same  Dr.  Fisher  who  had  been  Speaker  of  the  First  General 
Assembly  of  the  Territon'  of  Illinois,  which  met  in  Kaskaskia  in  1S12. 

This  little  handful  of  lawmakers  was  brought  together,  however,  by  the 
stern  necessities  of  the  infant  Territory,  and  their  sessions,  informal  as  they 
were,  placed  an  indelible  imprint  upon  the  future  government  of  Territory 
and  State.  Perhaps  no  member  of  the  .\ssembly  appreciated  so  keenly  as 
did  the  S])eaker  of  the  House,  Dr.  I-'islier,  the  necessity  for  the  restriction 
of  itinerant  and  ignorant  medical  jiractitiuners  throughout  the  Territory,  and 
if  he  did  not  cause  the  introduction  of  ibe  territorial  Medical  Practice  Act, 
it  is  certain  that  he  lent  his  influence  to  it. 

.\mong  the  important  laws  passed  by  this  Third  General  .-Vssembly  was 
one  regulating  the  practice  of  medicine.  This  pre-state  Medical  Practice 
Act,  bearing  the  signature  of  Dr.  George  Fisher,  Speaker  of  the  House,  and 
Pierre  Menard.  President  of  the  Legislative  Couttcil  (which  corresponded  to 
our  present  Senate)  and  the  approval  under  date  of  December  31,  ISIT,  of 
Xinian  Edwards,  Governor  of  the  Territory  of  Illinois,  read  as  follows: 

(2T3) 


874  EXKOKCE.MK.N'T   OF    iMEDICAL    rKACTlCK   ACT 

"LAWS    OF    ILLINOIS    TERRITORY— 1817-1818. 

"A.\  Act  to  iiirorjioratt'  Medical  Sucictics  for  the  purpose  of  regulatinij  the  practice 
of  Phyxics  and  titirpcry  in  this  Territory. 

"WHEREAS.  Well  regulated  medical  societies  have  been  found  to  contribute 
to  tlie  diffusion  of  true  science,  and  particularly  the  knowledge  of  the  healing  art, 
therefore  be  it 

"Enacted.  By  the  Legislative  Council  and  House  of  Representatives  of  the 
Illinois  territory,  and  it  is  hereby  enacted  by  the  authority  of  the  same,  that  this 
territory  be  and  is  hereby  divided  into  two  medical  districts,  and  shall  be  called 
the  eastern  and  western  districts;  the  eastern  district  shall  be  composed  of  that 
part  of  the  territory  lying  east  of  the  meridian  line  running  due  north  from  the 
mouth  of  the  Ohio;   and  the  western  district  of  that  part   lying  west  of  said  line. 

"Section  2.  Be  it  further  enacted.  That  it  shall  and  may  be  lawful  for  the 
following  persons:  J.  D.  Woolverton,  J.  E.  Throgmorton.  Thomas  Shannon,  Henry 
Oldham,  James  Wilson,  John  Reid.  Amos  Chipp.  Samuel  R.  Campbell.  Harden  M. 
Wetherford  in  the  eastern  district,  and  Joseph  Bowers,  Dr.  Todd  of  Edwardsville, 
Dr.  Hancock  of  St.  Clair,  Caldwell  Carnes,  George  Fisher,  William  L.  Reynolds, 
Dr.  Heath  of  St.  Clair,  George  Cadwell  and  Dr.  Paine  of  Kaskaskia,  to  meet  to- 
gether on  the  first  Monday  of  May.  in  the  year  of  our  Lord  eighteen  hundred  and 
eighteen,  at  the  towns  of  Carmi  and  Kaskaskia,  in  their  respective  districts,  and 
being  so  convened  as  aforesaid,  or  any  of  them,  being  not  less  than  five  in  number, 
shall  proceed  to  the  choice  of  a  president,  vice-president,  secretary  and  treasurer, 
who  shall  hold  their  offices  for  one  year,  and  until  others  shall  be  chosen  in  their 
places;  and  whenever  the  said  societies  shall  be  organized  as  aforesaid,  they  are 
hereby  declared  to  be  bodies  politic  and  corporate,  in  fact  and  in  name,  by  the 
names  of  the  'Medical  Society  of  the  district,"  where  such  society  shall  be  respec- 
tively formed;  and  by  that  name  shall  in  law  be  capable  of  suing  and  being  sued, 
pleading  and  being  impleaded,  and  answering  and  being  answered  unto,  defend- 
ing and  being  defended,  in  all  courts  and  places,  and  in  all  matters  and  causes 
whatsoever,  and  shall  and  may  have  a  common  seal,  and  may  alter  and  renew 
the  same  at  pleasure;  and  the  said  medical  societies  shall  and  may  agree  upon 
the  times  and  places  of  their  next  meeting,  which  shall  thereafter  be  the  anni- 
versary day  of  holding  their  respective  meetings. 

"Section  3.  Be  it  further  enacted.  That  the  medical  societies  established  as 
aforesaid  are  hereby  respectively  empowered  to  examine  all  students  who  shall  or 
may  present  themselves  for  that  purpose,  and  give  diplomas,  under  the  hand  of  the 
president  and  seal  of  such  society,  before  whom  such  student  shall  be  examined; 
which  diploma  shall  be  sufficient  to  empower  the  person  so  obtaining  the  same, 
to  practice  physic  or  surgery,  or  both,  as  shall  be  set  forth  in  the  said  diploma,  in 
any  part  of  the  territory.  And  the  person  receiving  such  diploma,  shall  upon  the 
receipt  of  the  same  pay  to  the  president  of  said  society,  the  sum  of  ten  dollars,  for 
the  use  of  said  society. 

"Section  4.  Be  it  further  enacted.  That  it  may  be  lawful  for  the  medical 
societies  established  as  aforesaid,  at  their  annual  meetings,  to  appoint  not  less 
than  three  nor  more  than  five  censors  to  continue  in  office  each  year,  and  until 
others  are  chosen;  and  it  shall  be  the  duty  of  each  one  of  them,  carefully  and 
Impartially  to  examine  all  students  who  shall  present  themselves  for  that  purpose 
before  each  of  them,  and  report  their  opinions  respectively  in  writing  to  the 
president  of  said  society,  and  upon  such  report  of  any  one  of  said  censors,  if  favor- 
able, the  president  is  hereby  authorized  to  license  such  student  to  practice  physic 
or  surgery,  or  both,  until  the  next  annual  meeting  of  the  medical  society;  and 
for  such  license,  such  student  shall  pay  one  dollar  to  the  president  for  the  use  of 
the  society. 

"Section  5.  Be  it  further  enacted.  That  from  and  after  the  organization  of 
the  said  medical  societies  in  the  respective  districts,  no  person  shall  commence  the 
practice  of  physic  or  surgery  in  either  of  the  aforesaid  districts,  until  he  shall 
have  passed  an  examination  and  received  a  diploma,  or  license  as  aforesaid;  and 
if  any  person  shall  so  practice  without  having  obtained  a  diploma  or  license  for 


Where  the  remains  of  Dr.  George  Fisher  rest  in  undisturbed  peace  on 
a  bluff  near  Modoc  in  Randolph  County  near  St.  Leo's  Church, 
enacted  in  Illinois  in  1817.  (Illustration  usid  by  coiirtesy  of  Dr. 
Lucius  H.  XiKch.j 


27G  KXKOKCKMKNT  Ol"    MEDICAL    PRACTICI-:   ACT 

that  purpose,  ho  shall  t'orever  thereafter  he  di  squall  tied  from  collec'ing  any  debt 
or  (Ichts  incurred  Ijy  such  practice,  in  any  cuurt,  or  before  any  nuigistrate  in  the 
territory. 

"Section  6.  15c  it  further  enacted.  That  it  shall  and  may  be  lawful  for  the 
medical  societies  which  shall  be  established  by  virtue  of  this  act,  to  purchase  and 
hold  any  estate,  real  and  personal,  for  the  use  of  the  societies  respectively;  Pro- 
vided, such  estate  as  well  real  as  personal,  which  the  said  societies  are  hereby 
respectively  authorized  to  hold,  shall  not  exceed  the  sum  of  twenty  thousand  dol- 
lars. 

"Section  7.  Bs  it  further  enacted.  That  it  shall  be  lawful  for  the  respective 
societies  to  be  established  by  this  act.  to  make  such  by-laws,  rules  and  regulations, 
relative  to  the  affairs,  concerns  and  property  of  said  societies,  relative  to  the 
admission  and  expulsion  of  members,  relative  to  such  donations  and  contributions, 
as  they  or  a  majority  of  the  members  at  their  annual  meetings  shall  think  fit  and 
proper;  Provider},  the  by-laws,  rules  and  regulations  be  not  contrary  to,  nor  in- 
consistent with  the  ordinance,  and  laws  in  force  in  this  territory:  nor  the  Consti- 
tution and  law's  of  the  United  States. 

"Sections.  Be  it  further  enacted.  That  the  treasurer  of  each  society  estab- 
lished as  aforesaid,  shall  receive  and  be  accountable  for  all  monies  that  shall  come 
into  his  hands,  by  virtue  of  any  of  the  by-laws  of  such  society;  and  also  for  all 
monies  that  shall  come  into  the  hands  of  the  president,  for  the  admission  of  mem- 
bers or  licensing  students;  which  monies  the  said  president  is  hereby  required 
to  pay  over  to  the  said  treasurer,  who  shall  account  therefor  to  the  society  at 
their  annual  meetings;  and  no  monies  shall  be  drawn  from  the  treasurer  unless 
such  sums  and  for  such  purposes  as  shall  be  agreed  upon  by  a  majority  of  the 
society  at  their  annual  meetings,  and  by  a.  warrant  for  that  purpose,  signed  by  the 
president. 

"Section  9.  Be  it  further  enacted.  That  it  shall  be  the  duty  of  the  Secretary 
of  each  of  the  medical  societies  to  be  established  by  virtue  of  this  act,  to  provide 
a  book,  in  which  shall  be  made  an  entry  of  all  the  resolutions  and  proceedings, 
which  may  be  had  from  time  to  time;  and  also  the  name  of  each  and  every  mem- 
ber of  said  society,  and  the  time  of  his  admission,  and  also  the  annual  report 
relative  to  the  state  of  the  treasury,  and  all  such  other  things  as  a  majority  of  the 
society  shall  think  proper,  to  which  book  any  member  of  the  society  may  at  any 
time  have  recourse,  and  the  same  together  with  all  books,  papers,  and  records, 
which  may  be  in  the  hands  of  the  secretary,  and  be  the  property  of  the  society, 
shall  be  delivered  to  his  successor  in  office. 

"Section  10.  Be  it  further  enacted.  That  it  shall  be  lawful  for  each  of  the 
medical  societies  to  be  established  by  virtue  of  this  act.  to  cause  to  be  raised  and 
collected  from  each  member  of  such  society,  a  sum  not  exceeding  ten  dollars,  in 
any  one  year,  for  the  purpose  of  procuring  a  medical  library  and  apparatus,  and 
for  the  encouragement  of  useful  discoveries  in  chemistry,  botany,  and  such  other 
improvements  as  the  majority  of  the  society  shall  think  proper. 

"Section  11.  Be  it  further  enacted.  That  nothing  in  this  act  containe.i,  shall 
be  construed  to  prevent  any  person  coming  from  any  state,  territory  or  country 
from  practicing  physic  or  surgery  in  this  territory;  such  person  being  duly  author- 
ized to  practice  by  the  laws  of  such  state,  territory  or  country,  and  having  a  di- 
ploma from  any  such  medical  society. 

"Section  12.  Be  it  further  enacted.  That  it  shall  be  in  the  power  of  the 
legislature  of  this  territory,  and  of  the  legislature  of  the  state,  to  be  formed 
out  of  this  territory,  to  alter,  modify  and  repeal  this  act.  whenever  they  shall 
deem  it  necessary  or  expedient. 

"Section  13.  Be  it  furCier  enacted,  That  this  act  shall  be  and  hereby  is  de- 
clared to  be  a  public  act,  and  to  take  effect  from  and  after  its  passage. 

"GEORGE   FISHER, 

Speaker  of  the  House  of  Representatives. 
"PIERRE    MENARD. 

President  of  the  Legislative  Council. 
"Approved — December  .31.  1S17." 


EXFORCEMEXT   OF    MEDICAL    PRACTICE   ACT  277 

The  law  required  each  gnuip  to  nicei  on  the  first  Monday  in  May,  ISIS. 
The  eastern  group  met  at  C'aniii,  ilie  western  group  at  Kaskaskia.  It  re- 
quired five  to  make  a  i|U()nini,  and  the  officers  consisted  of  president,  vice- 
president,  secretary  and  treastn-er. 

It  is  generally  supposed  that  Dr.  George  Fisher  was  the  father  and  ]irime 
mover  in  the  various  steps  necessary  to  place  this  Medical  Practice  Act  on 
the  statute  books. 

Practice  Act  of  181  !•. 

When  this  legislation  came  to  a  natural  death  with  the  termination  of 
the  territorial  government,  it  is  reasonable  to  believe  that  this  group  of  18 
men,  who  constituted  the  memhershiij  of  the  two  boards  for  enforcement  of 
the  provisions  of  the  early  pre-state  Medical  Practice  Act.  knowing  from 
experience  the  great  need  for  the  control  of  medical  practice,  were  largely 
instrumental  in  having  the  first  State  legislatiirt-  in  isl'.i  pass  an  "Act  for 
Establishment  of  Medical  Societies,"  among  the  ]  in  visions  of  which  were  the 
licensing  of  physicians  and  the  rcjiortin^  of  birihs  and  deaths.  Indeed, 
the  1S19  Medical  Practice  .\ct  in  man\-  particulars  is  ([uite  similar  to  the 
territorial  law  nf   1817. 

So  it  would  seem  that  he  who,  in  later  years,  spoke  of  Illinois  as  "the 
j)ioneer  in  practical  mecHcal  education,"  but  who  was  unaware  of  the  jjrecocity 
of  the  State  in  the  control  of  medical  practice,  placed  his  words  of  praise 
upon  a  commonwealth  which,  piobal)l\'  earlier  in  its  history  than  any  other 
^tate,  enacted  medical   piactice  hiws   for  the  protection   of   its   jeople. 

The  -\ct  of  ISK,  which  died  with  the  termination  of  territorial  govern- 
ment, but  which  was  resurrected  in  ISII),  to  die  again  after  an  unsuccessful 
attempt  to  enforce  its  provisions  in  a  land  ni  unmeasured  prairies  and  wddd- 
lands,  and  of  sparsest  settlement,  is  of  more  than  passing  interest  to  the  his- 
torian. It  was  the  initial  law,  the  blazed  tree  in  the  trail  of  melical  advance- 
ment, and  it  served  a  practical  purpose  in  directing  the  policies  along  thi-^ 
line  for  later  general  assemblies.  It  indicated  that  during  the  earli::'st  in- 
fancy of  the  State,  the  contiol  (if  me(lical  |)r:iclice  was  regarded  as  essential 
to  llie  best  government,  and  that  impression  h;is  remained  to  bear  fruit  in  a 
later  day  and  .generation  when  the  enforcement  (if  law  is  a  far  simiiler  matter 
than  .'il  the  time  when  Illinois  dexeloped  "fmni  ,ui  Indiana  ci>uiU\  into  a 
lerritoi)-  of  the  second  .grade." 

Kepeat,  ok  Til  K  I  SI!)  Act. 

In  [>■>].  the  Act  id'  ISl!),  which  pro\  ided  f(ir  the  urganizalion  of  medi- 
cal societies,  with  certain  powers  to  regulate  the  jiractice  r\  medicine,  with 
the  object  of  providing  improved  medical  st.andards  and  attention  to  public 


278  ENFOUCEMICXT   OF    MF.niCAI.    PKACTICK    ACT 

hcallh.  was  ri-|icaK(l.  This  was  a  Ircnu-iidoiis  back-set  to  the  regulation  of 
iiirilical  praclicr  in  lllinnis.  An  attenipt  tn  pass  a  law  similar  to  the  one  that 
had  been  repealed  was  made  in  ls■^•),  hul  did  not  suecced.  A  second  law. 
known  as  "an  Act  prt'scriliini;  ihe  nio(k-  nf  licensing;  physicians"  was  jjassed 
in   \!^'!'i.  hnl   was  promptly  i'e|iealed  at  the  next  session  ol'  the  legislature. 

I  low  liadly  a  law  rei^nlatinn  medical  practice  was  reallv  needed  is  sug- 
gested by  this  stalenunt  by  William  lUane  in  his  "A  d'our  in  Southern  Illi- 
nois," published  in   Is;"-';  : 

"Persons  who  have  not  visited  the  western  states  cannot  have  any  idea  of 
the  general  ignorance  ot  the  practitioners  of  medicine.  A  young  man,  after  an 
apprenticeship  of  a  year  or  two  in  tlie  shop  of  some  ignorant  apothecary,  or  after 
a  very  superficial  course  of  study  at  some  school  or  college  is  entitled  to  cure 
(or  kill)  all  the  unhappy  backwoodsmen  who  may  apply  to  him  for  advice.  To 
become  a  doctor  it  is  only  necessary  to  have  a  caliin  containing  .jO  to  100  dollars 
worth   of  drugs." 

The  foll( w  inij  partial  statement  fiiim  Zeuch's  "History  of  Medical  Prac- 
tice" indicates  ib.it  wholes.ile  barter  in  certificates  to  practice  medicine  de- 
veloped in  the  .Stati-  in  the  absence  of  law>  re^ulatint;  the  piactice  of  medi- 
cine : 

"When  this  Thomsonian  system  was  at  its  height  a  great  number  of  cer- 
tificates were  sold,  

"Joseph  Chapman  was  the  holder  of  the  certificate,  which  shows  one  of 
the  methods  employed  in  the  olden  times  in  creating  a  practitioner  of  medicine. 
When  the  tide  of  the  Thomsonian  school  was  at  its  flood,  a  large  number  of 
these  certificates  were  sold,  giving  the  holder  thereof  the  right  to  practice  medi- 
cine. Without  any  medical  study  except  such  as  was  furnished  vi'ith  this  cer- 
tificate, any  man  who  would  pay  the  price  was  permitted  to  prescribe  for  the 
sick  and  administer  such  remedies  as  were  endorsed  by  this  particular  cult, 
which  was  founded  on  the  use  of  remedies  ot  vegetable  origin  only,  discarding 
all  remedies  which  belonged  to  the  mineral  Ivingdora. 

"No.  1398  Seventh  Edition 

"This  may  certify  that  we  have  received  of  .liiseiili  Chapman.  Twenty  Dollars. 
in  full  for  the  right  ot  preparing  and  using,  for  himself  and  family,  the  Medicine 
and  System  of  Practice  secured  to  Samuel  Thomson,  by  Letters  Patent  from  the 
President  of  the  United  States;  and  that  he  is  thereby  constituted  a  member  of  the 
Friendly  Botanic  Society,  and  is  entitled  to  an  enjoyment  of  all  the  privileges 
attached  to  membership  therein, 

"Dated   at   Alton   this   19th  day   of    1839. 

"R.  P.  Maxey.  Agt.  for  Pike,  Piatt  &  Co.,  .Agents  for  Samuel  Thomson." 

I'jAiii.v  EFi''(nri's  TO  (ii'.T  .V  Mi';iiic.\L  Practice  Act. 

That  there  rcm.iincd  the  hop.-  of  ^ecitrins;  a  medical  society  as  the  nn- 
cleits  for  pnnnotini;  a  ^nccessfid  campaign  for  ;i  Medical  Practice  Act,  is 
indicated  ]iy  the  I  louse  Records  of  the  ( ieneral  .\ssemblv  for  February 
■'].  l.s:;:).  which  >;iv  ".Mr.  Webb  of  While  C'ountv  ])re.sented  the  i)etition  of 
J'.  11.  I>r;idv,  tor  tlie  incorporation  ol  a  medica.l  society,  wl.icli  on  a  motion 
was  referred   to  C  rnnnitlee  on   I'.ducation." 


EXFORCEMEXT   OF    MEDICAL    PRACTICE   ACT  279 

Again  in  ISl".'  efforts  were  made  to  get  a  Medical  Practice  Act  passed. 
The  reports  of  the  General  Assenibly  show  that: 

"Mr.  Aiulerson  from  the  select  committee,  to  which  was  referred  the  pe- 
tition of  sundry  physicians  of  Shawneetown  praying  for  the  passage  of  a  law 
regulating  the  practice  of  medicine,  etc.,  made  a  report  at  length  on  the  subject, 
and  reported  a  bill  for  "An  Act  to  incorporate  the  Illinois  State  Medical  Society' 
which  was  read  the  first  time,  and  a  second  time  by  its  title. 

■'Mr.  Logan  moved  to  amend  the  bill  by  striking  out  all  after  the  enacting 
clause;  and  inserting  the  following:  'That  no  physician,  surgeon  or  lawyer  shall 
hereafter  be  entitled  to  sue  for,  or  recover  by  action  of  law.  his  or  their  fees 
for  services  rendered   as  such  physician,   surgeon   or   lawyer.' 

"The  report,  bill  and  proposed  amendment  were  laid  on  the  table  by  yeas 
and  nays;   55  yeas;   50  nays." 

The  Illinois  Aledical  and  Surgical  Jotirnal  in  October,  18-14.  in  an  edi- 
torial commenting  on  the  ajiproaching  meeting  of  the  State  Legislature  re- 
specting medical  jiractice.  said  in  part  as  follows: 

"As  the  period  for  the  session  of  the  Legislature  approaches  we  perceive 
a  disposition  of  many  members  of  the  profession  to  agitate  the  subject  of  medi- 
cal legislation.  *  *  *  There  is  at  present  no  special  legislative  enactments  re- 
lating to  the  practice  of  medicine  in  the  State  of  Illinois.  Every  one  is  entitled 
to  assume  to  himself  the  title  of  'M.  D.'  to  prescribe  any  or  all  substances  in  the 
three  kingdoms  of  nature  to  any  who  call  on  him  for  advice.   *   *   *   *" 

.\dded  impetus  to  the  agitation  for  a  Medical  Practice  Act  resttlted  from 
the  organization  in  18,50  of  the  Illinois  State  Medical  Society  at  Springfield 
in  the  lihriiry  of  the  Capitol  I'.uililing.  The  Chicago  .Medical  Suciety  was 
organized  the  same  year. 

In  1856  a  cominittee  was  aiJiiointed  by  the  .\esculapian  .Society  of  the 
Wabash  Valley  from  among  its  membership  to  go  befcjre  the  Illinois  legis- 
lature and  urge  upon  that  body  the  ])ruiiriety  of  enacting  a  law  creating  a 
State  Board  of  Health  regulating  the  practice  of  medicine  and  providing  for 
the  registration  of  births  and  deaths.  The  committee  did  the  duty  assigned 
to  it,  but  its  work  was  without  immediate  tangible  effect.  Early  in  ISiil  a 
second  committee  was  selected  for  the  same  ptirpose  and  consisted  of  Doctors 
D.  W.  Sterniont.  \\'illiani  M.  (chambers  and  John  Ten  Brook.  But  the  la- 
bors of  this  committee,  bke  that  of  it-,  iiredecessnr,  liore  no  immediate  per- 
ceptible reports. 

However,  at  a  meeting  of  the  Illinois  State  Medical  .Society  held  at 
Champaign  in  ]S1(i,  a  committee  was  appointed  for  a  purpose  similar  to 
those  of  the  .\escula])ian  in  Is.'iii  and  Isdl.  The  sentiment  'inr  a  n:edic,".i 
practice  act  expressed  in  ls5()  did  not  ciystalli/e  into  concerted  action  by  the 
medical  profession  until  a  (|uarter  of  a  century  had  passed.  Apparently 
the  organized  medical  profession  of  that  da\-  finally  became  convinced  that 
to  enforce  adequately  a  medical  practice  act.  if  secured,  a  State  Board  nf 
Health  would  be  required.  At  least  the  following  indicates  that  these  two 
subjects  were   jointl\-   in  the  minds  of   some  oi   the  members  of  the   State 


VSI)  K.XFORCKMICXT   Ol"    M  KDICAL    I'RACTICK   ACT 

Mrdical    Society,      'riie  Transactions  of  the   'iUh   Anniversary   Meetinjj   of 
Illinois  Meilical  Societ)'  in  1877,  page  255,  says: 

"The  Jersey  County  Medical  Society  of  Illinois  sends  greetings  to  the  Illi- 
nois State  Medical  Society,  pledging  our  vigilant  exertions  in  helping  to  secure 
the  enforcement  of  such  laws  as  you  may  be  able  to  secure  the  enactment  of.  by 
either  the  State  or  National   Legislature,   looking  to   the  e.5tablishment  of: 

"A  State  Board  of  Health. 

"Causing  the  registration  of  births  and  deaths  and  certificates  as  to  the 
cause  of  the  latter. 

"Preventing  those  persons  unqualified  to  practice  medicine  from   doing  so 

"Creating  a  State  Board  of  Medical  Examiners." 

( )n  the  twenty-first  day  of  ]\Iay,  1S7T,  the  legislature — after  a  lapse 
of  over  fifty  years  from  the  date  of  the  repeal  of  the  short,  imperfect  Acts 
of  ISI!)  and  IS-.','),  placed  upon  the  statute  hooks  an  act  to  regulate  the  prac- 
tice of  medicine  in  the  State  of  Illinois,  approved  May  '''K  1M17.  and  m  force 

July  1.  is;;. 

'rh:it  the  Medical   rr;ictice  Act  came  none  too  soon  and  that  the  jjatient 

of  is;;  who  c.'ime  into  the  hands  of  the  manv  suh-standard  practitioners  of 

medicine  fared  none  too  well,  are  deductions  that  may  well  be  permitted  by 

the  ideas  exiiressed  in  the  following  quotation  from  the  December  17,  is;;, 

elition  of  the  Chicago  Inter-Ocean  daily: 

"It  is  hardly  necessary  to  say  that  the  city  of  Chicago  has  become  noted, 
not  only  for  the  immense  number  of  villainous  quacks,  but  for  the  ignorant 
and  imperfect  manner  in  which  the  register  of  births  and  deaths  has  been  kept. 
The  infant  who  was  reported  as  having  died  of  'canker  rash,  diphtheria,  dysentery 
and  consumption.'  and  another  whose  cause  of  death  was  returned  as  'five  doc- 
tors,' doubtless  had  good  reason  to  die;  and  'delicate  from  birth.'  'infancy.'  'stop- 
page.' 'fits.'  'Colerafantum.'  'collocinphanton.'  'cholry  fanton.'  'bled,'  'direars' 
(, diarrhea),  'billirm  (delirium)  fever,'  'artry  lung  busted.'  'feusson.'  (effusion), 
'canker  on  brane,'  and  'infermation  lungs,'  probably  convey  some  ideas  to  the 
persons  who  write  the  terms;  but  such  returns  cannot  be  of  much  use  from 
a  statistical  point  of  view.  The  importance  of  correct  and  intelligent  registra- 
tion cannot  be  underestimated,  as  modern  sanitary  science  owes  its  existence 
to  the  registration  of  deaths  and  the  localization  thereby  of  insanitary  conditions. 
It  is  right  that  the  enforcement  of  the  two  bills,  passed  by  the  Legislature  of  the 
State,  that  will  make  such  radical  change  both  in  medical  profession  and  the 
method   of  registering  births  and   deaths,   should   demand   considerable   attention." 

(io\ernor  (^'ullom  prom|itl\'  appointed  a  ISoard  i  f  llealth  in  confovmitv 
with  the  new  law  ot  is;;  and  the  appointees  met  in  Springfield  on  julv  1"^ 
of  that  year  when  tlu-y  organizeil  with  Dr.  John   H.  Ranch  as  ])resident. 

The  State  i'io:ird  of  1  le:iUh,  imme(liatel\  after  its  apjiointnun'.  weighed 
the  urgencv  of  the  duties  and  i  lilii^ations  placed  ujion  it  In-  the  newly  enacted 
laws  and  decided  that  its  first  dul\  was  to  enforce  tin-  Medical  Practice 
Act.  The  knowledge  tJKit  o\er  half  of  the  ;.I00  |iersons  jiracticing  medi- 
cine in  is;;  were  non-graduates  (about  :i.s()i))  and  that  4!l(J  were  practicing 
medicine  uncU-r  fr;mdulent  credentials,  or  even  under  assumed  names,  made 
this  decision   iel;ili\el\'  easv. 


ENFORCEMENT  OK    MEDICAL    PRACTICE    ACT  281 

Not  only  did  the  Board  of  Health  decide  first  to  center  its  chief  atten- 
tion .on  the  enforcement  of  the  Medical  Practice  Act,  but  a  careful  peru>al 
of  the  minutes  of  the  Board  of  Health  from  IS"  down  to  IHK.  indicates 
clearly  that  this  feature  of  their  legally  prescribed  duties  ciMisnmed  fully 
three- fourths  of  the  time,  energy  and  resources  of  the  Board, 

()n  Xovember  l.'>,  is;;,  the  following  resolutions  were  adopted  by  the 
State  Board  of  Health, 

"That  on  and  after  July  1,  1S7S  the  Board  will  not  consider  any  medical 
college  in  good  standing  which  holds  two  graduating  courses   in   one   year. 

"Also,  that  on  and  after  July  1.  1878  the  Board  will  not  recognize  the  diplomas 
of  any  medical  school  which  does  not  require  of  its  candidates  for  graduation 
the  actual  attendance  upon  at  least  two  full  courses  of  lectures  at  an  interval 
of  six  months  or  more." 

This  was  the  first  oflicial  ste])  taken  by  the  Board  for  higher  medical 
education. 

During  the  first  year  (1S77)  cei-tificates  totalLng  5,3 74  were  issued  by 
the  State  Board  to  practitioners  and  midwives.  By  1880,  enforcement  of 
the  Medical  Practice  Act  had  materially  reduced  the  number  of  ([uacks  and 
itinerant  vendors.  Likewise  the  number  of  graduates  in  Illinois  who  were 
from  reputable  medical  schools  had  increased  from  3, 600  to  4,s-J,"), 

In  the  Annual  Report  of  ISSl.  the  Board  printed  for  the  first  time  a 
com])lete  ofitcial  register  by  counties  of  physicians  registered  to  practice 
medicine,  also  a  directcry  of  medical  societies  in  Illinois  in  1881,  and  a  roster 
of  midwi\-es  registered,  listed  by  counties,  .\n  alphabetic  index  of  physi- 
cians is  also  printed  in  this  report. 

By  1882  the  certificates  issued  to  practitioners  and  miil\\i\es  totalled 
7,7GG,  an  increase  of  2,392  since  the  md  of  is;;. 

Standards  for  Mkdicai.  Education. 

In  ISSl  minimtmi  standards  for  preliminar\-  education  of  entrants  into 
medical  schools  and  requirement>  for  medical  colleges  in  good  standing  were 
established.  An  examination  of  all  candidates  with  diplomas  from  medical 
schools   not    meeting   these    re(|uirenients,    w;is   reiinireil, 

,\t  the  ckjse  of  the  year  ISS,"i.  ilu-re  were  in  round  numbers  (),U1)U  |)rac- 
titioners  of  medicine  in  the  State.  The  <  )fiicial  Register,  published  and  re- 
vised to  February  10,  1886,  contained  the  names,  addresses,  etc.,  of  5,11]  5. 
to  which  are  added  some  150  others,  exempt  from  the  clause  requiring  cer- 
tificates. Of  this  number  454  were  added  during  the  year;  114  applicants 
for  certificates  failed  to  comply  with  the  law  and  were  refused:  and  the 
certificates  of  eight  practitioners  were  re\(iked  fur  unprofessional  and  di.-- 
honorable  conduct. 


282 


ENFORCEMKNT  OF   MKDUAl.    I'kACTiri':   ACT 


ReVTSKU   MkDK'AL    I'liACTUE   A("r   Anol'TED. 

'I'hc  Aci  111  l\cL;iilaU'  the  Tractice  (it  .Medicine,  addpli-d  in  ISTl,  was 
amended  mi  June  lii.  l^s;.  and  in  liree  Jnly  1.  l.^S^.  Tile  amendments 
strucl\  imt  llie  |ir(i\isinns  dl'  tiie  (iriLjinal  act  relating  tii  the  appointment 
of  boards  of  examiners  i)_\-  State  medii-al  sdcieties,  provided  for  three  classes 
of  certilicates  instead  of  twu.  The  third  class  applied  to  [lersons  who  were 
licensed  ti.i  practice  on  accunnt  nf  lo  vears  ]irevi()ns  exi)erience.  It  also 
pnixided  that  snch  certilicates  slidnld  he  applied  for  within  six  months  after 
the  act  went  intu  el'feci,  and  that  all  pt-rsims  hnldini;  certilicates  on  account 
of  It-i  years  (if  previous  practice,  slujuld  be  subject  to  all  re(|uirements  and 
discijjline  of  the  act. 

The  fee  for  the  issuance  of  certificates  without  examination  was  raised 
from  line  di  liar  tn  h\e  dollars,  and  a  iirovision  was  made  f(ir  the  issuance 
of  certihcates  to  midwives,   for  a  fee  of  two  dollars. 

.Minimum  requirements  for  schools  of  midwifery  were  adopted  May  24, 
IS.S!). 

.\  comparative  table  published  in  1S!I0  gives  the  status  of  the  enforce- 
ment of  the  Medical  Practice  .\ct  and  the  registration  of  jihysicians  as  fol- 
lows ;  For  purposes  of  comparison,  the  following  totals  from  each  of  the 
five  registers  are  here  presented : 


Jan.  14, 
18S0. 

Dec.  29, 
1881. 

Dec.  1, 
1884. 

Feb.  9, 
1886. 

Jan.  1, 
1890. 

Total  number  engaged  in  practice 

Graduates    and    licentiates    of   medical   insti- 

6,029 

4,282 

191 
948 
•608 

6,037 

4,488 

183 
896 
•470 

6.148 
4,882 

6,115 
.5.098 

6,215 
5,524 

Licentiates  upon  examination  of  State  Board 
of    Health    

139                   145 
757                   672 

116 

575 

lO 

"*  Since  the  completion  of  this  Register,  a  careful  examination  has  disclosed  the  fact  that 
there  were  about  fift.v  more  non-graduates  in  the  state  than  were  supi-oseii,  consequently  this  num- 
ber has  been  addixl  in  the  above  tabic  to  the  nuiuber  of  'e.vempls,  not  certificated'  for  each  of  the 
years    1880.    1881,    1884,    and    1886. 

"i  No  exempts  under  the  law  at  this  tune— and  no  teiliHciites  ba.-<cd  on  vears  of  practice,  will  be 
issued    hen-after." 

From  the  abiixe  tabular  statement  it  will  he  seen  that  the  number  of 
those  engaged  in  medical  practice  in  the  lirst  10  years  of  the  Hi  ardV  activi- 
ties is  nearl\-  the  same,  notwithstanding  that  there  was  marked  increase  of 
population:  also  while  the  aggregate  number  of  ]iractitioners  has  not  nia- 
tei'iallv  varied,  there  were  some  noticealile  changes  in  the  numbers  of  the 
dili'ereiit  classes.  Thu>.  there  was  a  gain  of  1.1  li;  graduates  aiiil  licentiates — 
these  fiiiniing  HI  per  cent  of  the  total  number  in  ISilO,  as  against  about  7G 
per  cent  in  Issii;  the  number  of  licentiates  upon  examination  of  the  State 
Board   was  lar^elv   diminished — mainl\-   bv   their   transfer  to  the   number  of 


ENFOUCIiMEXT  OK    MEDICAL    I'KACTICE    ACT  383 

graduates,  very  many  of  them  having  subsequent  to  their  examination,  at- 
tended lectures  and  ol)tnined  diplomas ;  also  to  the  fact  th:it  few  are  added 
to  this  class  owing  to  the  increased  severity  of  the  examinations  given  by 
the  Board. 

The  following  summary,  from  the  first  Register,  and  ciirresponding  fig- 
ures from  the  1S!H1  report,  exiiibit  these  changes  for  tlie  whole  period  since 
the  Aledical  Practice  Act  went  into  operation: 

July  1,  1877.      .I:in.  1,  1S90. 

Tutal   iiiiinlier   ensas'ecl   in  practice 7,400  6,215 

<:i:i.luntes    anil    licentiates 3,600  5,640 

Non-grrailiiates - - 3,800  575 

Percentaf^e  of  graduates  and  licentiates   in    1877 - - "18 

Percentage   of  gra<lliiites  and   licentiates   January   1,    1890 91 

Percentage    of    nun-graduates    in    1877 52 

Percentaee  of  non-sraduates  January  1,   189D - 9 

DurinsT  the  lieriod  yf  its  existence  or  up  to  January  1,  1890,   the  Board   has  issued  certificates  to 

physicians    - 10,453 

To  i^raduates  and  licentiates  of  medical  institutions 8,949 

To   exempts  on  years  of   practice 1,228 

To  licentiates  uiion   examination,   State   Board   of  Health 246 

"Diplomas  or  licenses  have  been  presented  by  those  now  in  practice  in  the  state  from  151  medical 
colle£es  and  licensim;  bodies  in  tlie  United  States,  from  18  in  Germany,  18  in  Great  Britain  and  Ire- 
land. 13  in  Canada,  8  in  Switzer  and,  6  in  Russia,  4  in  Austria,  2  in  Sweden.  2  in  France.  1  in  Denmark, 
1  in  Norway,  1  in  Maderia,  1  in  Slain.  1  in  Bolivia,  1  in  Italy.  I  in  Bclsinm,  1  in  UruRuay— making  a 
tnlal  of  230  graduating  or  licensing  bodies  represcnti'il." 

In  1.S92  the  State  Board  of  Health  recommended  lor  the  consideration 
of  the  legislature,  the  desiraliiliU'  of  reheviiig  the  Board  from  the  enforce- 
ment of  the  Medical  I'raclice  .\ct  by  the  creation  of  a  I'xiard  uf  Medical 
Examiners,  wh(jse  duty  it  should  lie  to  determine  the  fitness  for  the  practice 
of  medicine  in  the  State,  by  examination  of  candi<Iates,  without  reference 
to  when,  where  or  how  they  attained  their  fitness. 

A  res(jlution  was  also  adopted  pro\-iding  that  all  applicants  for  a  State 
certificate  to  practice  midwifcr\'  in  Illinois  must  pass  a  satisfac1t)ry  examina- 
tion given  l)y  the  Board. 

The  proposition  of  establishing  a  separate  licensing  board  was  again 
taken  up  in  ISiKi,  when  a  committee  was  appoimed  representing  the  Illinois 
Stale  Medical  Society;  the  liomeoiiathic  State  Society;  iht  Illinois  State 
Eclectic  Medical  .'Society,  and  the  State  Board  of  Health,  for  tlie  purpose  of 
considering  a  plan  to  be  iireseiited  to  the  legislature  to  .amend  the  Medical 
Practice  Act  so  as  to  require  an  examination  by  an  impartial  board,  of  all 
applicants  to  practice  medicine  in  the  State  of  Illinois.  At  the  same  time, 
the  committee  on  administration  of  the  Medical  Practice  Act  submitted  the 
rules  and  regulations  governing  the  recognition  of  schools  of  midwifery. 

.\  resolution  was  adoiited  that  no  medical  college  sh.ill  be  recognized  as 
in  good  standing  for  the  ]nirpose  of  the  Illinois  Medical  Practice  Act,  that 
fl( fs  not  rri|uire  of  all  matriculates,  after  January  1,  PSUT,  as  a  condition  of 
grailuation,  a  four  years'  course  of  lectures  in  four  separate  years. 


284  ENKOUCICMl'.XT   0¥    MEDICAL    PRACTICE   ACT 

An  investigation  of  nit-dical  colleges  made  in  1897,  revealed  the  necessity 
for  a  law  prohibiting  issuance  of  State  charters  to  educational  institutions, 
or  giving  them  i)ower  to  cnnfer  degrees  initil  inspected  and  approved.  A 
new  >clu'ilule  nf  niininiuni  re(|uircnients  for  the  regulation  of  medical  ccil- 
leges  was  also  adopted.  This  year  a  hill  was  ])assed  providing  for  the  regu- 
lation of  the  practice  of  o.steopathy  in  the  Stale  of  Illinois,  hut  ( iovernor 
Tanner  vetoed  this  measure,  because  the  "act  is  clearly  in  the  nature  of  class 
legislation." 

The  Hoard  also  agreed  hereafter  not  to  recognize  any  foreign  diploma 
as  a  basis  upon  which  to  issue  a  certificate  to  practice  medicine  and  surgery 
in  the  State,  and  that  all  a|iplicants  holding  such  di])lonias  shall  be  required 
to  pass  an  examination. 

Interstate  reciprocity  was  ailopted  in  1899.  The  ;Medical  Practice  Act 
was  amended  again  this  year  ;uid  broadened  so  as  to  provide  for  the  examina- 
tion and  licensing  of  persons  who  desire  to  practice  any  other  science  or 
system  of  treating  human  ailments. 

At  the  annual  meeting  of  the  Illinois  State  Medical  Society  held  at 
Quincv,  Mav  ■Jii--.'-j.  Wwri,  a  proijosed  Bill  for  an  Act  to  Establish  a  State 
Board  of  Medical  b-xaniiners  was  presented  and  received  ai)]iroval  of  the 
Society  as  a  whole. 

The  Medical  Practice  Act  was  further  amended  in  19UT  by  embodying 
a  i)rovision  empowering  the  State  Board  of  Health  to  determine  the  stand- 
ard of  lilerarv  and  scientific  colleges,  high  schools,  etc..  to  be  accepted  for 
prelinnnarv  etlucation  of  medical  students,  and  to  require  the  enforcement 
of  a  standard  of  i)reliminary  education  by  medical  colleges;  also  providing 
for  reciiirocitv  and  granting  of  the  compensation  to  members  of  the  examin- 
ing biard  f(jr  their  services. 

In  19  1."i  a  law  was  passed  amending  the  Medical  Practice  Act  by  giving 
the  Hoard  jurisdiction  over  certificates  issued  to  all  physicians  licensed  in 
the  .'-^tatc  under  the  various  medical  laws. 

(  )tiikk  PiiAcrrnoXERS. 
Xeitlur  the    .\le<lical    Practice   Act   of    is;;    nor  tliat   of    iss;    ni.ake  any 
UK'nlion   of   or  give   provision    for   licensing   "other  (jractitioners." 

hi  ihe  llMi:!  report  of  the  Board  of  Health  on  page  XLlll  v,-e  bnd  the 
following: 

-REQUIREMENTS   FOR   'THOSE    WHO    DESIRE   TO   PRACTICE   ANY    OTHER 
SYSTEM   OR   SCIENCE   OF   TREATING   HUMAN   AILMENTS.' 
Iii.'<trniti(ni.s    lit    Apiiliidnts. 
"Stale  Certiticates  autliori/.iiis  piTsons  who  do  not   use  medicines  internally 
or   externally   and    who   do   not    perl'orni   .surgical    operations,   to   treat   human   ail- 
ments, are  issued  by   the   State   Board   of   Health,   on   complying   with   certain   re- 
(luirements.    based    upon    the    Act    to    Regulate    the    Practice   of    Medicine    in    the 
State  of  Illinois,  in  force  .July  1,  ISSCJ." 


EXFORCEMEXT   ill-    .Ml;iiU    \L    I'KACTICE    ACT  385 

Mi/lirlre.s. 

While  the  1<"^T;  Medical  Practice  Act  referred  onl_\-  to  persons  pracliciii .; 

medicine  in  anv  of  its  departments  and  made  no  reference  to  niid\vi\es,  the 

State  Board  of   Health  at  a   Cairo  meetini;  on   Nmeniber    1."),    Is7;.  made 

the  following  statement : 

"The  Board  in  entering  upon  the  enforcement  of  the  medical  practice  act, 
considered  it  imperative  to  attend  to  the  demands  made  upon  it  by  general  prac- 
titioners, and  paid  little  attention  to  midwives.  Four  hundred  and  twenty  four 
certificates  have  however  been  issued  to  midwives.  a  comparatively  large  number, 
taking  into  consideration  that  owing  to  the  amount  of  time  and  labor  needed  for 
issuing  of  certificates  to  medical  practitioners,  the  systematic  work  of  licensing 
midwives  did  not  begin  till  a  very  recent  date.  In  many  counties  of  the  state 
the  proportion  of  midwives  to  general  practitioners  of  medicine  is  very  large — 
and  much  remains  to  be  done  to  secure  their  complete  licensing  and  registration." 

And  again  at  the  first  annual  meeting  January   10,  ls;s,  we  note  th.s 

comment : 

"By  vote  of  the  Board  it  v/as  resolved  that  midwives  be  placed  upon  the 
ranie  basis  under  the  law,  so  far  as  the  requirement  for  certificates  to  practice  are 
concerned,  as  practitioners  of  medicine." 

The  1S,S7  Aledical  Practice  Act  makes  no  specific  recjuirements  for  li- 
censing midwives  but  under  Fees  for  Examination  says  : 

"The  fees  for  the  examination  of  non-graduates  shall  be  as  follows:  Twenty 
($20)  dollars  for  examination  in  Medicine  and  Surgery.  Ten  ($10)  dollars  for 
an  examination  in  midwifery  only." 

The  l^iDU  Act  in  the  second  section  pru\ides:  "No  person  shall  here- 
after begin  the  practice  of  medicine  or  an\  nf  the  branches  thereof,  or  mid- 
wifery in  this  State  without  first  ajiplying  fur  and  nbtaining  a  license  from 
the  Slate  Board  of  Health  to  do  so." 

The  official  register  of  midwives  h;iving  a  State  certificate  issued  by  the 
Board  since  ISTT  totalled  1,470  in   IS!i(i. 

Eiiihnliiicrs. 

The  official  rules  of  the  State'  Board  of  Health  for  the  transportation 
I  if  the  dead  based  on  an  "Act  providing  for  the  Regulation  of  Embalming 
and  the  disposal  of  deail  bodies"  apjiroved  Mav  l'>,  l!H).j,  were  promulgated 
and  gi\en   wiile  pulilicitv  in    11107,  and  all  ciincerned   were  informed: 

"It  is  the  duty  of  every  Embalraer  in  the  State  of  Illinois  to  thoroughly 
familiarize  himself  with  every  provision  of  these  rules,  the  rigid  enforcement 
of  which  is  essential  to  the  proper  operation  of  the  law  under  which  they  were 
created." 

REeujLATiox  OF  !Meiih'al  PKA("ri(  k  Transferred  to  Department  of 
Rkcisthatiox  and  Education. 

Through  the  enactment  in  1'.I17  of  tlu'  .\dministrative  Code,  the  re- 
sijonsibility  for  "the  rights,  powers  and  duties  vested  liv  law  in  the  State 


2S6  KNFORCKMK.N'T  OF    MKDICAL   PKACTICE  ACT 

Board  of  Health  relating  to  the  practice  of  medicine,  or  any  of  the  branches 
therrof,  or  midwifery,  *  *  *  *  the  regulation  of  the  embalming  and  disposal 
of  dead  bodies,  and  for  a  system  of  examination,  registration  and  licensing 
of  enibalmers,"  was  transferred  to  the  Department  of  Registration  and  Edu- 
cation. Thus  for  the  first  tiiue  since  LSVT,  the  State  Department  of  Public 
ilialth  which  w.is  created  Ijy  this  Act,  was  free  to  give  the  important  sub- 
ject of  jiulilic  health  the  fair  share  of  the  attention  it  merited. 


AUXILIARY  HEALTH  AGENCIES. 

Jn  the  ])ninii  tiiin  of  ln-alth  in  Illinnis  the  State  and  local  dejiartmenls 
of  health  ha\e  had  the  aid  of  nian\-  health  agencies.  Some  of  these  are 
arms  of  government  and  some  are  not.  .^ome  are  known  as  health  agencies 
and  act  directly  as  such.  Others  are  known  1)\-  other  names  and  their  con- 
tribution is  more  indirect.     Some  are  naticjnal  and  some  are  local. 

The  legislature  in  providing  health  laws  and  the  courts  in  interj)reting 
them  have  made  their  contribution.  The  collateral  administrative  officers 
in  other  departments  have  made  theirs.  The  contribution  of  go\-ernors  and 
of  the  heads  t'f  the  de])artments  of  education,  agricultiu'e.  imblic  welfare 
and  labor,  have  been  outstanding.  Among  the  national  organizations  that 
have  helped  to  jjromote  health  in  the  State  are  the  United  States  I'ublic 
Health  .Service.  Children's  Bureau.  U.  S.  Department  of  Labor.  U.  S.  De- 
partment of  Agriculture,  the  International  Health  Board,  American  Public 
Health  Association,  American  Child  Health  Association,  National  Tubercu- 
losis Association  and  National  Educational  Association.  Among  the  more 
active  agencies  operating  principally  within  the  State  are  those,  some  of 
the  activities  of  which  are  detailed  on  the  following  j)ages. 

Quasi  Public  Health  Agencies. 

Ilt.ix(ii,s  Mkduwl  Sdciktv. 

The  Illinois  Alcdical  Society  has  been  in  continuous  existence  since 
1850.  While  their  main  objective  is  the  education  ui  ].)hysicians  in  the 
methods  of  curative  medicine,  keeping  them  abreast  of  the  times  and  other- 
wise piromoting  the  professional  interest  of  their  mem1)ers.  thev  have  not 
been  unmindful  of  the  duties  of  the  medical  profession  in  the  field  of  pre- 
vention. For  many  years  one  of  the  sections  of  this  Societv  has  been - 
that  of  preventive  nie<licine.  The  journal  of  the  .Society  carries  the  papers 
read  in  this  section  to  the  oftices  and  homes  of  all  the  memliershi]).  There 
are  those  who  hold  that  in  the  di\ision  of  labor  in  the  held  of  ])re\entive 
medicine  the  medical  societies  can  justifv  themselves  in  a  policy  of  limiting 
their  work  to  education  of  physicians  in  preventive  measures  and  kee]i- 
ing  them  al)reast  of  all  ad\-ances  in  this  held.  This  activity  the  Illinois 
-Medical  Society  does  through  the  .Section  on  Preventive  Medicine,  but 
they  do  other  work  as  well. 

Their  large  share  of  credit  for  the  law  creating  a  State  public  health 
service  is  referred  to  elsewhere.  Their  committee  at  Springfield  has  lent 
its    support   to   legislation    for    the    public   health    at    e\erv    session    of    the 

(28:) 


288  .\U.X11.1.\K\-    lllCAI.TIi    AGENCIES 

GeiR-ral  A.ssi-niljly  for  many  years.  The  expense  of  tliis  is  home  in  part 
nul  uf  Sceiely  funds  and  in  ])arl  out  nf  snh>cri])tiijns  and  dnnatidus  hv 
iu(Hvidual   nienil)ers  of   the   profession. 

In  llMi:;  the  Chicago  Medical  Society  organized  a  course  of  lectinx's 
on  hc:dih  suiijrcls  for  lay  hearers,  'i'hese  lectures  were  held  in  the  ])uhlic 
lihrary  weekly   for  ahout   two  years. 

In  111-.'-.'  ilu-  Illinois  .Mt-dical  Society  ])ro\ided  tor  a  similar  activit\- 
under  ihe  auspices  of  an  h'.dncation  Committee.  This  Committee  began 
work  in  \'.>->'-\.  Their  report  for  January  1  to  'Mux  12.  i'JT,  made  in  Mav 
111",'^   indicates  the  nature  of  tlu-ir  slate  wide  activities. 

Seven  counties  in  the  State  have  made  definite  use  of  the  service  offered 
through  the  Educational  Committee  during  these  four  and  one-half  months. 
The  other  counties  have  made  use  of  the  st'r\ice  indirecth'. 

Eighty-eight  requests  for  sjieakers  have  been  tilled  to  date.  The 
members  of  the  speakers'  Inirean  have  a])peared  before  such  groups  as 
Kiwanis,  Lions,  Rotary,  Optimist  clubs,  women's  clubs,  churches,  parent- 
teacher  associations,  teachers'  institutes,  home  bureaus,  Y.  M.  C.  A.,  Y.  \\'. 
C.  A.  groups,  and  boy  and  girl  scouts. 

A  speakers'  bureau  of  colored  physicians  and  another  of  foreign  speak- 
ing physicians  ha\e  been  organized  in  order  to  widen  the  circle  reached 
through  health  talks. 

Thirty-nine  new'spapers  are  using  the  health  articles  release;l  from 
the  office  of  the  Educational  Committee  as  a  regular  feature.  These  articles 
ai>ix'ar  in  all  cases  imder  the  signature  of  the  local  medical  societies.  Eight 
hiiudrt-d   health  articles  ha\  e  been   released  to  the   newspapers  in  the   State. 

b"ifty-nine  radio  ])rogranis  have  been  arranged  for  o\er  stations,  V\'CiN, 
WllT,  W'l.S,  W-MAO  and  WQ].  Reports  have  come  from  Wisconsin, 
Iowa,  Michigan  and  Indiana  as  well  as  from  manv  parts  of  Illinois  com- 
mending these  programs  most  highly. 

Forty-tw'O  moving  picture  films  have  been  scheduled  for  use  by  lay 
groups.  These  have  been  obtained  from  the  State  Department  of  I'ublic 
Health,  the  American  Dental  Association,  the  University  of  Wisconsin,  and 
the  Society  for  Visual  Education. 

Fi^■e  communities  have  had  splendid  poster  exhibits  in  connection  with 
s])ecial  health  i\a\  |)rogr,ims  through  the  courlesv  of  tlie  lulucational  Com- 
mittee. 

Coojieralion  has  been  given  to  certain  projects  of  the  .^tate  Depart- 
ment of  Public  Mealtli.  such  as  furnishing  speakers,  films  and  posture 
exhibits   for  various  groups  during  Health  Week, 

The  Connnittee  has  worked  with  the  Illinois  Federation  of  Women's 
Club^  in  urging  clul)  women  to  cooperate  with  county  medical  societies  in 


AUXILIARY    HEALTH    AGENCIES  ^8!) 

all  health  activities.  Letters  have  been  sent  out  empliasizing  the  import- 
ance of  educating  the  pubhc  on  the  subject  of  cancer. 

.\l)proach  has  been  made  to  all  county  societies  where  baljy  ci infer- 
ences ha\c  been  held  in  cooperation  with  the  child  hygiene  dixision  of 
the  State  Department  of  Public  Health.  Through  this  introduction  comity 
societies  were  enabled  to  work  out  their  own  plans  with  the  State  Depart- 
ment of    Public  Health. 

TIk'  committee  ser\cs  as  a  clearing  house  in  making  ci^ntacts  with 
la\    organizations. 

During  National  Baby  \\'eek  ])rograms  were  arranged  and  speakers 
supjilied  for  several  department  stores  in  Chicago.  Special  radio  talks 
were  also  given  by  physicians  and  dentists. 

(  )ne  hundred  dentists  were  given  complete  [ihysical  examinations  at 
the  amiual  meeting  of  the  Chicago  Dental  Society  in  V.'i'i'i.  Twenty-five 
physicians  were  examined  at  the  meeting  of  the  Illinois  State  Medical 
Society  at  Aloline  in  May  of  the  same  year. 

The  promotion  of  periodic  physical  examinations  has  been  one  of  the 
more  recent  public  activities  of  the  Illinois  Medical  Society. 

Illinois  Fkdeeation  of  AVomex's  Clvbs. 

This  organization  has  been  of  material  sup])ort  in  furthering  health 
measures.  .\boiU  1012  when  the  war  <  n  consumption  down-state  was  in 
need  of  friends,  the  Federation  through  its  local  clubs  and  district  or- 
ganizations made  a  survev  of  tuberculosis  throughout  the  .State.  The  facts 
revealed  by  this  survey  and  the  local  interest  stimulated  by  it  was  largely 
res])onsible  fcT  the  County  Tuberculo>is  .Sanitarium  bill  and  for  support  of 
the  county  sanatoria  throughout  the  State.  At  this  time  they  are  especially 
interested  in  promoting  the  physical  and  mental  examination  of  children  of 
preschool  age. 

Illinois  SoriExy  for  the  Pkevention  of  Blindness. 

In  I'.ilo  in  Chicago  ten  babies  became  blind  as  a  result  of  neglected 
ophthalmia  neonatorum.  This  led  to  the  formation  of  the  Illinois  Society 
tor  the  Preventicn  of  Blindness.  Before  1915  only  30  cases  a  year  of 
ophthalmia  neonatorum  were  reported.  During  1926  nearly  600  such  cases 
were  reported.  This  does  not  mean  that  there  is  more  of  the  infection. 
It  means  only  that  the  cases  are  now  recognized  and  properly  treated.  There 
has  been  a  marked  reduction  in  the  mnnber  made  blind  }earl\-  and  also  in 
the  number  of  graxe  infections. 


290  AUXII.IAUN     mCAl.TH    AGENCIES 

TIk'  Society's  lirst  task  was  lo  promote  the  juissagc  of  a  law  requiring 
that  gonococcal  infections  of  the  eye  be  prevented  by  the  compulsory  use 
of  nitrate  of  silver  and  that  cases  of  the  disease  lie  reported.  They  have 
helped  in  the  enforcement  of  the  law.  The  preventive  is  now  supiilied  free 
by  the  State  Department  of  Public  Health. 

The  Society  has  promoted  trachoma  surveys  and  clinics,  also  examina- 
tion of  children  for  usual  defects.  They  have  conducted  work  in  Chi- 
cago and  in  the  State  outside  Chicago. 

The  other  interest  of  this  Society  is  in  the  poor  vision  found  among 
school  children.  The  Society  works  down-state  as  well  as  in  Chicago,  in 
making  surveys  of  existing  conditions,  securing  relief  for  those  who  are 
handicapped  by  eye  defects  and  in  helping  them  to  useful  occupations,  and 
also  in  educating  and  interesting  people  in  the  prevention  of  poor  vision. 

Chicago  Tuberculosis  Institute. 

The  present  Chicago  Tuberculosis  Institute  had  its  begmning  in  the 
Visiting  Nurses  Association  in  1902.  Miss  Fulmer,  the  superintendent  of 
nurses  wrote  her  board  calling  their  attention  to  the  gi'eat  amount  of  time 
and  money  spent  by  their  organization  in  nursing  and  otherwise  helping 
persons  sick  with  consumption.  She  suggested  that  some  money,  brains 
and  energy  spent  in  jirevention  would  eventually  save  something  in  money, 
brains  and  energy  spent  in  care  and  occasional  cure. 

As  a  result  of  this  communication  the  Visiting  Nurses  Association 
called  a  meeting  of  physicians  and  other  interested  persons,  members  of  their 
board  to  convene  in  the  rooms  of  the  Association  on  January  21,  1903. 
This  meeting  organized  a  committee  on  tuberculosis.  The  Association  voted 
$2,000  as  a  part  of  funds  necessary  to  start  the  work.  The  plan  of  activities 
adojjted  was  that  proposed  by  Dr.  A.  C.  Klebs.  In  ]\Iarch,  1903.  this  Com- 
mittee began  to  function  in  rooms  adjacent  to  those  of  the  Visiting  Nurses 
Association.  By  October,  1903,  the  Committee  reported  67  cases  of  con- 
sumption under  their  direction.  In  November,  1903  it  was  reported  that 
a  course  of  lectures  on  tuberculosis  had  been  arranged  for. 

In  March  1905,  this  Committee  sent  a  letter  to  the  \'isiting  Nurses 
Association  proposing  that  the  Tuberculosis  Committee  form  a  separate 
organization.  The  \'isiting  Nurses  Association  replied  that  they  consid- 
ered that  the  time  had  come  to  consummate  that. 

At  the  third  annual  meeting  of  the  Tuberculosis  Committee  of  the 
\'isiting  Nurses  Association  held  January  27,  1906,  the  Chicago  Tuliercu- 
losis  Society  was  fonned  to  take  o\er  the  activities  of  the  Committee.  This 
was  in  efTect  nothing  more  than  creating  a  new  form  and  selecting  a  new 
name  for  the  old  Committee  and  its  work.     The  change  was  made  with  the 


AUXILIAK^    iii:ai.tii  agencies  ^91 

appnival  of  tlie  Xisitint,^  Xiirses  Assuciation  ln-cause  it  was  thought  the 
wurk  could  be  hcttur  tlonc  by  a  separate  org'anization.  Most  of  the  old  com- 
mittee members  continued  active  in  the  new  organization  and  two  of  them, 
Mrs.  E.  C.  Dudley  and  Dr.  W.  A.  livans  have  been  in  continuous  service 
since  and  are  still  active. 

March  1,  li'06,  the  name  was  changed  to  the  Chicago  Tuberculosis 
Institute.     It  was  chartered  March   i;.  1 !(()(!. 

.\t  first  the  Society  did  nothing  except  educational  work,  study  and 
propaganda. 

On  September  1.  l!t()(i,  they  established  a  temporary  sanitorium  or  camp 
on  the  grounds  of  the  Dunning  institutions.  It  was  known  as  Camp  Nor- 
wood and  it  served  the  jniljlic  in  a  small  wav  from  that  date  tmtil  IMarch 
31,  1907. 

The  Institute  inaugurated  a  free  dispensary  service  on  May  15,  1907. 
This  was  gradually  extended  as  to  the  number  of  dispensaries  operated 
and  the  variety  of  service  given  until  .September  1.  1010  on  which  date 
the  service  in  its  entirety  was  handed  over  to  the  Mimicipal  I'uljcrculosis 
Sanitarium. 

On  May  27,  1907,  after  an  interruption  <jf  about  two  months  the  In- 
stitute went  back  into  the  Ijusiness  of  operating  a  philanthropic  sanitarium 
through  their  acceptance  from  Mrs.  Keith  Spalding  of  Edward  Sanitar- 
ium at  Nai)erville,  Illinois. 

In  the  beginning  the  acti\ities  of  the  Committee,  Society  and  Institute 
were  supported  by  funds  from  the  \isiting  Xnrses  Association  and  dona- 
tions from  the  public  at  large. 

In  1908  the  system  of  raising  money  by  the  sale  of  Christmas  seals 
was  inaugurated.  This  has  been  the  principal,  in  fact  almost  the  sole  means, 
of  raising  money  since  that  date.  Seals  ha\  e  been  sold  each  December 
with  the  exception  of  191S  in  which  \-ear  bv  special  arrangement  the  funds 
were  supplied  out  of  the  nation-w  i<le  conmumity  chest  collected  for  the 
purpose  of   suppirting  all   |ihilanthi-()pic  home  activities  in  war  time. 

(  )n  .\pril  1(1,  1910,  a  meeting  to  organize  a  State  Tuljerculosis  Society 
was  held  in  the  offices  (}f  the  Chicago  Tuberculosis  Institute.  Ihis  meet- 
ing was  attended  by  Doctors  Sala  of  Rock  Island,  Hardesty  of  Jacksonville 
and  Wallace  of  Peoria  and  a  number  of  persons  from  Chicago:  it  was 
voted  to  organize  a  new  Society  out  of  the  old  State  Society  for  the  Pre- 
vention of  Tuberculosis.  The  Chicago  Tuberculosis  Societv  agreed  to  stand 
.all  the  preliminary  expense  of  this  reorganization.  On  June  10,  1910,  the 
new  .^tate  Society  was  organized  (out  of  the  old  Societv)  (taking  over 
its  charter).  It  was  then  voted  that  the  offices  of  the  new  society  should 
be  in  the  rooms  of  the  Chicago  Tuberculosis  Institute  and  that  the  superin- 


292  AUXILIAI-Cl'    IIKAI.TH    ACE.VCIES 

tciidcni  of  the  liistiuitf  also  st-rNc  llu-  State  Society  as  its  superintendent 
witlmnt  t'xiieiise  to  the  Stale  Society  for  either  rent  or  salary  of  the  super- 
intendent. At  a  later  date  the  State  Society  (•cctii>ied  se|iarate  rooms  hut 
adjacent  to  those  of  the  luslilnte.  Later  on  thev  employed  a  full-time  suix-r- 
illtendent.  still  later  the  offices  were   removed   to   S|)rin£;tield. 

Decemher  :)(i,  I'.MS,  the  officers  of  the  llliniiis  Society  for  the  Pre- 
vention of  Tuherculosis  completely  se])arated  the  (.'hicago  'fuherculosis  Insti- 
tute from  affiliation  with  them  creating  Cook  County  as  a  separate  juris- 
diction for  the  sale  of  Christmas  seals  and  the  doing  of  tuherculosis  work. 
On  Jannar\-  11.  JItl!),  this  action  of  the  Slate  Society  was  ap]iro\ed  by  the 
executive  comiuittee  of  the  National  Tuberculosis  Society. 

.Among  the  acts  and  activities  of  the  Chicago  Tufjerculosis  Institute 
found  recorded  in  the  minutes  in  addition  to  those  narrated  above  are  the 
following : 

Propaganda  lie  fore  the  legislature  for  a  State  sanitarium  and  for  a 
tulierculosis  bureau  in  the  State  Department  of  Health.  Propaganda  in  su]i- 
port  of  the  Glackin  law  for  a  municipal  sanitarium  in  1909.  Activity  in 
the  camiiaign  on  the  referendum  under  this  law  which  vote  established  the 
i\Tuiiici])al  Tuberculosis  Sanitarium.  Council  in  the  organization  of  the 
sanitarium  activities  under  that  act. 

On  Inly  17,  19ijT.  the  Chicago  Tuberculosis  Institute  turned  over 
to  the  city  health  de])artment  their  street  index  file  of  tuberculosis  and  the 
filing  cabinet  in  which  this  was  kept,  the  city  health  department  promis- 
ing to  keep  this  file  alive. 

They  helped  in  the  passage  of  the  Glackin  county  sanitarium  bills, 
the  pastt-urization  ordinance  and  various  laws  for  the  repression  of  bovine 
tuberculosis,  they  organized  stud\  classes  for  tuberculosis  in  industry  and 
for  the  scientilic  and  clinical  sliuh-  of  the  disease.  the\-  conducted  exhibi- 
tions and  issued  leaflets  and  ]iamphlets.  Their  present  major  activities 
are  as  follows  : 

A  general  nursing  service  in  more  than  one-half  the  countv.  This 
service  is  acti\e  in  the  control  of  all  forms  of  contagion.  'J'his  service 
is  rendered  in  coo])eration  with  the  county  and  local  health  departments. 
A  health  service  rendered  by  physicians  attending  a  number  of  health 
centers.  A  follow-np  service  for  persons  who  have  arrested  tuberculosis. 
A  health  sur\-ey  service.  A  course  of  leclnres  I'li  public  health  for  nurses 
in  training.  .\n  eniplo\nient  agencv  for  nurses  trained  in  tuberculosis  \\(irk. 
An  educational  and  propaganda  service.  A  srniilarium  service  and  ojier 
miscellaneous   services. 


auxiliary  health  agencies  293 

The  Illinois  Tuberci'losis  and  Health  Assoclvtiox. 

The  \oluntary  organization  which  has  done  more  to  prumote  general 
public  health  inijirovement  than  any  other  non-official  agency  in  the  Stale 
is  the  Illinois  Tuberculosis  and  Health  Association.  Originally  estalilished 
for  the  purpose  of  concentrating  its  efforts  against  tuberculosis  this  organi- 
zation became  in  time  a  [jowfrful  factor  in  the  general  held  of  public  health 
service  through  the  stimulation  of  local  public  health  nursing  ser\ices.  It 
changed  its  name  three  tinus  but  its  functidus,  while  emphasizing  tubercu- 
losis work  in  particular,  ha\e  included  general  activities  for  the  greater  part 
of  its  life. 

Through  the  sale  of  Christmas  seals  this  organization  has  had  more 
resources  than  any  other  volnntarv  agency  for  doing  health  work  in  the 
State  at  large.  These  haye  been  used  to  gocd  advantage,  residting  in  the 
establishment  of  local  voluntary  health  organizations,  local  nursing  services, 
tuberculosis  sanitariums  and  the  promotion  of  health  education.  Always 
the  policies  and  activities  have  conformed  with  standard  practices  set  up 
by  the  organized  medical  profession  and  the  public  health  authorities. 

The  organization  had  its  beginning  in  1 !)().'!  when  Dr.  J.  W.  Pettit  of 
Ottawa,  Illinois,  read  a  paper  on  consumption  before  the  lllimiis  State  Medi- 
cal Society.  Following  this  he  was  appointed  by  the  Society  to  the  chair- 
manship of  a  committee  on  tuberculosis  with  instructions  to  carry  out  what- 
ever plans  seemed  practical  and  advisable. 

The  National  Tuberculosis  Association  had  just  been  organized  in  New 
York  and  encouraged  with  the  interest  of  the  State  Medical  Sijciety,  Dr. 
I'ettit  sent  out  a  letter  on  December  li,  IHO-I,  calling  a  meeting  for  the  jjur- 
pose  of  organizing  an  Illinois  tuberculosis  association.  This  meeting  con- 
vened at  the  Great  Northern  Hotel.  Chicago,  December  14,  I'.)(i4.  Seven- 
teen attended.  The  outcome  was  a  plan,  which  later  materialized  into 
reality,  to  organize  an  association   t(.)   function  on  a  state-wide   scale. 

The  organization  was  called  the  Illinois  .Xssociation  for  the  I'reven- 
tion  of  Tuberculosis.  Dr.  .\.  C.  Klebs  was  elected  ])resi<Ient  and  Dr.  N.  A. 
Graves,  secretary. 

The  first  work  of  the  organizalinn  was  concentrateil  on  legislation  look- 
ing toward  the  establishment  of  a  State  tuberculosis  sanitariiun.  The 
further  objects  were  to  stimulate  the  formation  of  ancl  provide  assistance 
for  local  societies  in  all  the  towns  of  the  State  and  to  cooperate  with  the 
national  association   f(jr  the  study  ami   prevention   of   tul)erculosis. 

Funds  were  secured  through  the  sale  of  Christmas  seals.  The  lirst  sale 
was  conducted  in  IIMI,")  and  the  total  amount  raisi-d  was  *?1,'.'ihi.  ['resident 
James  of  the  L'niversitv  of  Illinois  was  elected  president  of  the  Association 
in  1905. 


294  AUXILIARY    IIKAI.TH    ACKNCllCS 

( )n  April  1(1.  1!M<).  ;i  rcorgaiiization  iiiiH-tiiii;  was  held,  using  the  fild 
charter  which  \\a^  dati'd  l*"chruary  7.  ItH)."),  ])r.  W.  A.  Evans,  Chicago  was 
elected  president  and  Mr.  Frank  E.  Wing  of  Chicago,  secretary. 

I'uur  local  organizations  ap])licd  for  affiliation.  The  purpose  of  the 
organization  was  again  stressed  emphasizing  educatinnal  work  and  nursing 
service  instead  of  material  relic'f   for  consumptives. 

In  191J:  the  .Modern  I  ieallh  Crusade  niii\enieiU  was  launc!ie<l  as  tile 
outcome  of  a  sur\ey  made  in   \\  idle  Cciunly. 

In  IIM  I  the  organization  cooperated  with  the  State  Department  of  Pub- 
lie  1  Ieallh  in  .a  health  exhibit  at  the  Illinois  State  Fair,  a  practice  that  has 
Cdutinued   Ui  dale. 

In  December  IHIS.  Cook  Counlv  was  createil  as  a  separate  org.iniza- 
tidu  for  the  sale  of  Christmas  seals,  and  earl\-  in  llMii  the  office  of  the  Illi- 
nois .\ssociation  for  the  Prevention  nf  Tuberculusis.  as  it  was  called  at  that 
time,  was  moved  to  Springfield  and  the  name  was  changed  to  the  Illinois 
Tuberculosis  Association. 

Some  of   the  tangible   results   of   acli\ities    for    which    the   .\ssociation 

was  entirely  or  largely  responsible,  according  to  records  a\ailable  in  August 

]!)'^^,  include  the  following: 

Public  health  nursiiiK  services  in  V2  counties. 

Tuberculosis  sanatoria  in  16  counties. 

Affiliated  or.i^anizations  in  104  dilferent  localities. 

Modern  health  crusade  functioning  in  S7  count ie.'^. 

Two  summer  camps  operating  for  undernourished  children. 

Christmas  seal  sale  organizations  in  every  county. 

In  IDl'.i  the  executive  secretary  cjf  the  Illinois  Tuberculosis  Association 
was  employed  by  the  imitate  Department  of  Public  Health  to  direct  a  state- 
wide project  known  as  Health  Pronu)tion  Week.  Hoth  organizations  i)iU 
a  very  large  share  of  their  joint  resources  behind  the  undertaking  which 
resulted  in  a  very  general  public  response.  This  ])roject  developed  into  an 
annual  affair,  conducted  by  the  State  Department  of  Public  Health,  which 
has  doubtless  exercised  considerable  influence  on  the  volume  of  public 
health  educational  achievements  in  the   State. 

'  liber  activities  of  the  As.sociation  include  the  jmblicatiou  of  a  monthlv 
be.ilib  educational  btdletin  called  ihe  ".\irow",  the  promotion  of  legisla- 
tion calenl.'ited  to  result  in  substantial  impro\ement  of  ])ublic  health,  the 
carrying  cut  of  tuberculosis  sur\eys  (such  surveys  have  been  made  at  least 
once  in  e\ery  county),  the  launching  of  "open  window"  and  anti-spitting 
campaigns  .anuu.alh-  and  con])eralion  with  legitimate  public  health  moxements 
generally. 

For  examijle  of  ihe  latter,  the  .Xssoci.alion  contribtited  $"350  tovvaixl  the 
salary  of  a  dentist  who  was  I'luployed  by  the  <lental  profession  of  the  State 


AUXILIARY    IIEAI.TII    AGENCIES  295 

and  placed  on  the  staff  of  the  State  Department  of  PubHc  Health  in  1026  as 
a  demonstration  of  what  could  be  done  by  promoting  dental  hygiene.  This 
demonstration  resulted  in  legislative  provision  for  carrying  on  the  work  by 
the  State  De])artment  of  Tublic  Health. 

Paeent-Teacher  Associations. 

This  is  an  organization  composed  of  teachers  in  the  grade  schools  and 
the  parents  of  the  pupils  therein.  It  is  a  liaison  organization  between  the 
schools  and  the  home.  Its  plan  is  to  have  a  local  society  for  the  parents 
and  teachers  of  each  school  to  consider  everything  that  makes  for  the  phy- 
sical and  mental  welfare  of  school  children.  A  recent  amendment  to  the 
[ilan  pro\ides  for  the  preparation  of  children  for  the  school  by  having  them 
examined  physically  and  mentally,  having  their  physical  defects  corrected 
and  having  them  vaccinated  against  such  diseases  as  diphtheria  and  small- 
pox all  before  they  reach  six  years  of  age  in  order  that  they  may  enter  the 
first  grade  in  the  best  possible  state  of  health  and  bodily  vigor. 

National,  Safety  Council. 

The  National  Safety  Council  calls  Illinois  its  home  state.  The  pre- 
liminary meeting  to  organize  this  Council  was  held  in  ^Milwaukee  in  11112. 
The  first  meeting  under  a  completed  organization  was  held  in  Chicago  in 
lit]  I  under  the  presidency  of  R.  W.  Campbell  of  the  Illinois  Steel  Company. 

Today  the  Council  has  4,312  members  and  spends  more  than  half  a  mil- 
lion dollars  annually. 

The  preliminary  meeting  in  1912  was  addressed  on  the  subject  of  "The 
Illinois  System  of  Factory  Inspection"  by  Edgar  T.  Davies.  It  was  prin- 
cipally by  virtue  of  the  Health,  Safety  and  Comfort  Act  that  this  Illinnis 
department  was  able  to  function. 

The  National  Council  stimulated  the  formation  of  a  Chicago  Industrial 
Safety  Council  to  function  in  Chicago  and  elsewhere  in  Illinois. 

The  principal  work  of  the  Safety  Council  is  to  lessen  the  number  of 
industrial  accidents,  through  propaganda  and  education  of  the  employers 
and  employees  and  promotion  of  the  general  use  of  safety  devices  and  safety 
methods.  They  have  devoted  some  time  to  an  objective  not  quite  so  directly 
in  their  field,  namely,  the  prevention  of  public  accidents  such  as  accidents 
on  the  streets  and  public  highways  and  in  the  home. 

They  likewise  promote  better  first  aid  service.  Since  191-1  there  has 
been  a  \ery  marked  decrease  in  industrial  accidents  both  fatal  and  non-fatal 
in  the  State.  The  Safety  Council  feels  that  this  field  of  need  is  being 
coxered  in  a  way  that  is  satisfying.  Not  so  the  field  of  street  or  public 
accidents.  The  fatal  accident  rate  composed  principally  of  public  or  street 
accidents  is  now  one  of  the  leading  causes  of  death. 


296  AU\ii.iAi<\    in:AMii   aiikni'iks 

(_'iiK'A(i()    IIkakt  ^VssOt'IATIOX. 

'I'he  Chiccigci  Heart  AssocialiDii  was  orijanizecl  in  <  )ctiil)ci",  llf.'".'.  the 
pui'ixjses  being  stated  as  follows — educatinn  nf  the  jjublic.  second — coordina- 
tion of  all  organizations  having  to  do  with  heart  diseases  and  the  establish- 
ment of  new  organizations  and  ])ninuitiiin  of  research  in  the  problems  of 
heart  disease  especially  as  it  relates  to  pulilic  health.  Since  1922  twelve 
cardiac  clinics  have  been  develojied  and  15,000  to  2.").()()()  pamphlets  have 
been  distributed  yearly ;  2500  numbers  of  a  quarterly  bulletin  are  sent  out 
four  times  a  year. 

The  Association  has  assisted  in  prucuring  facilities  for  the  care  of 
cardiac  convalescents  and  vacation  canip^  f(ir  cardiacs.  In  r.f.Ti  they  made 
a  study  of  cardiacs  in  industry. 

While  the  greater  part  of  the  present  program  relates  to  the  care  of 
those  already  having  heart  troubles  it  is  preventive  in  that  it  plans  to  pre- 
vent incapacity  due  tn  heart  disease  by  reason  of  broken  establishment.  The 
Association  plans  to  try  prevention  of  heart  disease  as  soon  as  the  basic  facts 
are  established. 

State  Heakt  Society. 

There  is  a  State  Heart  Society,  of  whicli  Dr.  C  11.  Diehl  is  ])resident, 
hut  it  has  not  functioned  yet. 

TiiK  C'lncAGO  League  for  the  Hard  of  Hearing. 

The  Chicago  League  for  the  Hard  of  Hearing  was  founded  in  January, 
liiHi.  It  now  has  a  meiubership  of  seven  hundred  and  sixteen.  The  activ- 
ities of  the  League  are,  teaching  lip  reading,  testing  apparatus  for  the  aid 
of  hearing,  making  surveys  of  the  degree  of  hearing  of  school  children,  the 
conditions  of  ears,  nose  and  throat  in  school  children  and  securing  care  for 
sch:Hil  children  who  have  infections  of  the  ears,  nose  and  throat. 

St.\te  and  L()(.'al  Dental  Societies. 

The  State  and  lucal  denial  societies  have  contrilnited  something  to  the 
imi)rovement  of  health  and  physical  vigor  by  aiding  health  departments  and 
schools  to  seciu-e  dental  clinics  in  the  schools  and  elsewhere  and  by  educa- 
tional and  projiaganda  cam|)aigns. 

IjAP.OIiATOIMKS   AND    rxiVKUSITIKS. 

The  lahoratories  and  universities  ha\'e  contributed  to  the  bettenneiil  of 
health  liy  re^cnrch  wurk  and  by  teaching  and  by  education  of  the  public. 

The  health  (lep.arinients  eagerly  seize  on  every  fact  l■slabli^lK•d  l)\  re- 
search either  in  labora.tury  or  in  hosiiital  or  in  universities  whether  in  Illinois 


AUXILIARY    HEALTH    AGENCIES  297 

or  elsewhere.     Some  part  of  the  improvement  is  due  tn  iiuHrect  aid  frum  all 
institutions  of  these  types. 

The  universities  and  colleges  further  contrihute  by  maintaining  a  health 
service  for  students  which  service  is  largely  in  fact  princi])ally  ])reventive  in 
character. 

Industrial  Physicians. 

The  industrial  physicians  have  an  opportunity  to  apply  preventive  medi- 
cine to  large  bodies  of  men  and  women  under  the  very  best  of  circumstances. 
Their  reconmiendations  of  changes  in  methods  and  in  environment  made  to 
the  management  are  generally  heeded.  Their  advice  to  employers  made  both 
directly  and  indirectly  through  foremen  carry  weight  and  influence.  The 
industrial  physicians  have  helped  the  health  camjiaign. 

Practicing  Physicians. 

Xo  other  group  renders  so  much  service  as  an  auxiliary  agency  as  do 
the  practicing  physicians.  They  are  constantly  rendering  service  in  pre- 
vention through  their  direct  contacts  with  their  clients.  They  periodically 
render  such  service  indirectly  through  their  local  medical  societies. 

Illinois  Society  for  ^Iental  Hvoikne. 

The  Illinois  Society  for  Mental  Hygiene  was  founded  in  1'.)i>li.  Its 
first  stafT  consisted  of  one  nurse  who  had  a  desk  in  the  wom.an's  club  in 
Chicago.  In  1!M1  some  adililional  perse  nnel  was  availed  of  hv  means  oi 
funds  set  aside  for  the  purpose  by  the  Lountv  judge  of  Cook  County.  This 
work  in  the  Cook  County  courts  was  taken  over  bv  the  court  in  1!»1.").  In 
]'J'i-)  the  need  of  definite  practical  training  in  mental  hygiene  for  social 
workers  was  demonstrated  to  the  social  service  agencies  in  Chicago.  A 
(healthj  demonstration  of  the  relation  of  meiUal  hygiene  to  personality 
difficulties  was  made  in  a  Chicago  high  school.  Local  meiUal  h\giene  com- 
mittees were  organized  in  two  Illinois  communities. 

A  survey  was  made  of  the  mental  hygiene  conditions  in  the  schools 
of  LaSalle.   Illinois. 

The  .'Society  helped  to  firing  about  the  organization  of  the  State  In- 
stitute for  Child  Ivesearcb.  Much  of  the  energy  of  the  Si;ciety  is  ex- 
pended  in   popnlar   education  and    proijaganda    for  menial    health. 

American   Hkh  Cross. 

The  .\merican  Red  Cross  first  entered  the  field  of  rural  nursing  in  I!)!".'. 
Their  actiyities  in  home  nursing  were  increased  when  the  State  troops 
were  called  to  the  border  in  I'.iKi.  A  program  of  dexelopinmi  on  a  large 
scale   was   adopted   in    l!ll!».      \\'hile  most   of  the   work   of   the   rural   nurses 


298  AUXILIARY    HEALTH    Ar,i:NCIES 

takes  the  loriii  of  Ijedsidc  luirsiiin-  of  the  sick  much  of  it  is  preventive  in 
character. 

In  April  !!,•"-'■;,  pubhc  heahh  nurses  were  employed  in  1 V  counties  as 
county,  school  or  community  nurses.  In  lifly-nine  of  these  counties  the 
American  Red  Cross  participated  in  inaugurating  the  service.  There  were 
seventeen  Red  Cross  chapters  employing  public  health  nurses.  Eight  of 
these  nurses  are  financed  entirely  by  the  Red  Cross  and  nine  jointly  by  the 
Red  Cross  and  otlur  agencies.  The  Red  Cross  conducts  nearly  five  hundred 
classes  yearly  in  home  hygiene  and  care  of  the  sick — issuing  certificates 
to  about  11,000  persons  yearly. 

The  following  are  some  of  the  (jrinciijles  of  the  nursing  service:  "The 
protection  of  the  jjublic  lualth  is  fundamentallv  a  governmental  problem 
but  at  the  same  time,  it  is  i  ne  that  re(|uires  the  intelligent  and  active  co- 
O])eration  of  the  iiuli\idual  citizen.  The  function  of  the  Ived  Cross  is  the 
pronK)tion  of  indi\i<lual  and  coninnmity  health  through  ])ersonal  service, 
group  instructii  n  and  general  health  propaganda."  The  duties  of  these 
nurses  are  given  as — "eradication  of  communicable  diseases,  health  educa- 
tion, nursing  care  of  the  sick,  of  mothers,  of  new  born  babies,  of  the 
tulieiculous  and  school  nursing." 

Amkhicax  Soc'ikty  fok  the  Control  ok  Cancer. 

The  American  Society  for  the  Control  of  Cancer  was  organized  at  the 
Clinical  Congress  of  Surgeons  held  in  New  York  City  in  1912,  (about). 
Soon  after  that  an  Illinois  branch  was  formed.  Dr.  Gilbert  Fitz-Patrick. 
present  chairman  of  the  Illinois  branch,  sets  September.  19<;(i  as  the  time 
of  rejuxenation  of  that  branch.  At  that  time  he  appeared  Ijcfore  the  coun- 
cil of  the  State  Medical  Society  and  secured  their  endorsement.  Since 
then  sixty-three  county  branches  have  been  organized  and  ,500  meetings  at- 
tended by  150,000  people  have  been  held.  "The  camjiaign  has  for  its  prime 
objective  teaching  the  people  ways  of  checking  their  disease  liabilities 
against  the  health  assets  through  the  jdiysical  examination  yearlv."  Cancer 
.has  pro\en  the  best  wedge  and  the  worst  topic  with  which  to  open  for 
discussion  the  to])ic  of  better  lu'alth. 

Illinois  Sihm.nl  IhciKxt:  TjEaole. 

(  )n  July  ]■'.  nnil.  three  Chicago  men,  Budd  C.  Corbus,  .M.  D.,  Mr. 
.Samuel  Carson  and  Mr.  Roger  Sherman  received  articles  of  incorporation 
for  an  organization  whose  objective  was  defined  as  "devoted  to  the  scien- 
tific observation  ;ind  study  of  diseases  and  cures  therefor."  but  whose 
constitution  limited  its  work  "to  the  study,  jjrevention  and  treatment  of 
venereal  diseases." 


AUXILIARY    HEALTH    AGENCIES  299 

At  the  first  annual  meeting;  Robert  H.  Gault,  professor  of  criminal 
law  and  criminolog}-  at  Northwestern  University  was  elected  president. 
An  active  campaign  of  prevention  and  education,  particularly  in  the  camps 
at  Fort  Sheridan,  Camp  Grant,  Grant  I'ark.  Great  Lakes  and  Municipal 
Pier,  was  carried  on. 

Prophylactic  stations  were  opened  at  the  League's  first  permanent 
home,  an  old  house  of  prostituticn  at  118  West  Grand  Avenue,  Chicago 
and  at  the  Xorthwestern  depot.  Cooperative  relations  were  established 
with  the  Illinois  State  Council  of  Defense,  the  British  Recruiting  Mission 
and  the  United  States  Examining  Boards. 

Exhibits  were  installed,  lecturers  trained  and  sent  out,  hundreds  of 
thousands  of  pamphlets  printed,  and  lantern-slides  made. 

A  comprehensive  survey  of  the  hospitals  and  dispensaries  of  Chicago 
with  reference  to  the  facilities  for  the  diagnosis  and  treatment  of  the 
venereal  diseases  was  made  in  behalf  of  the  League  by  i  )r.  Mary  L.  Lin- 
coln and  published,  April  S-t,  1917. 

The  name  was  changed  to  the  Illinois  Social  Hygiene  League  e.irl\  in 
1919.  Since  then  the  yearly  expenditures  for  charitable  treatment  and 
education  have  grown  to  nearly  $50,000  and  the  nimiber  of  treatments  given 
yearly  from  3,302  to  28,222  in  1926. 

When  Professor  Gault  left  Chicago,  Mr.  Charles  S.  Dering  became 
president  and  under  his  wise  leadership  and  that  of  Dr.  Louis  E.  Schmidt, 
who  succeeded  him,  the  constructive  contrilmtion  of  the  League  to  the  wel- 
fare of  societv  increased  materially. 

In  April,  I'J'i',.  the  League  moved  into  its  (jwn  building  a  com^iara- 
tively  new  four-story  Ijrick  business  structin"e  ideallv  located  and  con- 
structed for  teaching,  treating  and  training  purposes.  This  piuxhase  was 
made  possible  by  contributions  from  the  president,  Mr.  E.  S.  Me\er,  a 
member  of  the  board  of  directors,  Mr.  Albert  Knppenheimer  of  Chicago 
and  other  generous  Chicago  citizens. 

Here  the  League  conducts  separate  clinics  for  venereally  diseased  men. 
womeu  and  children,  an  exhibit  room  and  lecture  hall,  with  one  floor 
devoted  to  education  and  preventive  work.  I'^jur  full-time  jilnsicians  ]iro 
vide  the  service  in  return  for  post-graduate  instruction  jjIus  an  honnrarium 
while  ten  or  twelve  medical  men  and  women  of  experience  and  abilit\' 
provide  the  instruction  and  me<lical  supervision.  0\ev  100  jiatients  ;i  da\ 
are  treateil  here  for  sypliiHs  and  gonorrhea  while  nwv  loo.ooo  instruc- 
tive pamphlets  are  distributed  vearlv  bv  the  education.il  ilepartnient.  TOO 
lectures  given  and  many  exhibits  set  up.  The  League  has  a  lilni  librar}- 
of  35  reels  of  educational  films  which  is  in  constant  u.se.  Research  work  in 
cooperation  with  the  U.  S.  Public  Health  Service  has  been  organized  and 


300  AUXII.IARN     HEALTH    AGEN'CIKS 

an  (.•llicienl  lahoraldry  i)r()vi<lr(l  where  it  is  carried  on  wiili  tlie  assistance 
ol  the  League  staff  and  students  from  \'(H-tii\\t'stern  L'ni\ersil\-  Medical 
College. 

Plans  are  afoot  for  a  further  increase  of  activity  lookins;  toward  a 
coniprehensi\e  program  for  the  uUimate  i-radicalion  of  the  \enereal  disease 
il   >iich  a  thing  is  possihle. 

The  work  done  in  Illinois  outside  of  Chicago  is  liiuiled  to  propaganda 
and  edticalional  acti\ities. 

Citii.niM'.N  "s   I  Iiisi'i  I'Ai.  Socii'-.TV  A.xn   Mii.k   Commission. 

In  Decemlier  1!hi-^.  folUnving  the  \isit  of  Dr.  A.  Lorenz  of  X'ienna, 
a  movement  was  set  on  foot  liy  the  WHnian'.s  lluh  reform  de].)artinent 
to  provide  Chicago  with  facilities  for  sick  children. 

This  meeting  resulted  in  the  organization  of  the  Children's  Hospital 
Society  of  Chicago.  Dr.  Frank  Billings  was  elected  president.  Mrs]  Harold 
McCormick.  secretary.  Mr.  E.,  G.  Keith,  treasurer  and  Mrs.  Flora  G.  Moul- 
ton.  chairman  of  the  Membership  Committee. 

In  .May,  lIMi:;,  this  Society  organized  the  Milk  Commission  of  Chicago. 
This  .Milk  (.ommission  remainerl  active  thereafter  although  the  parent 
society    (the  Children's   llcjspital  Society)   appeared  to  have  lapsed. 

Mr.  and  Mrs.  Nathan  Straus  of  New  York  donated  to  this  Society 
a  pasteiuizing  ]ilain  which  through  the  conrtesv  of  the  Chicago  Board  of 
liducation  was  located  in  the  basement  of  the  Thomas  Hoyne  .'School,  Cass 
and  Illinois  streets.  Chicago. 

Dr.  1.  .\.  Alit  was  chairman  of  this  (  cinimission  and  Mrs.  I'lummei 
anil  .Mrs.  .Moulton  were  in  control  of  tlu'  plant.  They  began  distrilniting 
nnlk  1  n  July  ;,  i:to:!.  and  continued  until  .\o\ember  28,  1!)03.  In  this  time 
tbe\-  distriliuted  ■.'■.'■.'.( mm)  bottles  of  pasteurizecl  modified  milk.  It  was  sold 
below    cost   thiough  thirt)-one  milk  stations. 

The  lal)or.itor\  work  on  this  milk  was  done  without  cost  by  the  C'olum- 
bus  Medical  l.ahuratorv  through  Dr.  .Vdolph  ( lehrman.  -\t  a  public  meeting 
to  promote  this  acii\it\'  helfl  at  the  Chicago  Woman's  Club.  May  21i. 
1903.  speeches  \vere  made  b\-  Mrs.  Chas.  Henroten,  Dr.  V.  Billings,  Miss 
Jane  Addams,  .Mrs.  Ceo.  I'lunimei-.  Mr.  Steve  Sumner  of  the  milk  drivers 
union.  Mr.  11.  B.  Farmer  of  the  milk  shippers  union,  j.  E.  Allen,  Chicago 
and  North  Western  Railroad,  Professor  IC  (  ).  Jordan.  Dr.  -\.  R.  Reynolds. 
Dr.  I.  .\.  Abt.  James  Cheeseman,  Dr.  W.  S.  Christopher,  .Mr.  II.  1'..  (  lurler 
;ind   Dr.   Kosa  lutgelnian. 

In  l!Hi:')  the  C'ommission  continue<I  distributing  nnlk.  Thev  inaugurated 
inspection  of  farms,  visitation  of  babies  in  the  Immes.  mothers'  meetings  and 
a  series  of  educational  articles  in  the  Chicago    rribune.     The  secretary  pro- 


AUXILIARY    HEALTH    AGEXCIES  301 

nounced  the  work  of  the  Commission  as  "An  educative  benexolent  one  of 
instruction,  example  and  protection  where  no  mere  law  can  reach."  In 
their  minutes  we  read  that  Northwestern  University  medical  schmil  estab- 
lished a  diet  kitchen  in  December,  1902. 

Alsd  that  as  the  years  passed  bv  St.  Louis  and  other  cities  established 
ciiniiiiissidus  modeled  after  that  of  (/hicai.;(). 

In  Alav  ]!H)1,  one  of  the  educational  articles  was  on  the  sul>iect  ol 
Stale  supervision  of  milk  b_\-  E.   i\.  Eaton. 

Erom  this  article  we  learn  that  the  Illinois  legislature  passed  a  law 
in  1S74  which  prohibited  the  adulteration  of  milk  under  a  penalty  of  $")(HI 
In  18T!)  they  passed  a  law  prohibiting  the  selling  of  impure  milk  and  also 
the  selling  of  milk  from  diseased  cows.     The  penalty  was  $10(i. 

In  1S97  they  provided  for  State  standards  for  milk.  In  IS'.MI  another 
law  created  the  office  of  State  food  commission  and  ga\e  them  some  control 
over  milk. 

An  interesting  report  on  the  wi.rk  of  I'.KKl  is  a  report  of  the  home 
and  dairy  visits  of  a  field  worker.  .Much  of  her  time  was  s|)eiit  in  in- 
structing mothers  how  to  keep  their  babies  well. 

This  t}-])e  of  actixitv  was  continued  for  sexeral  vears.  (  In  |ul\  'i  I,  l!t()S, 
the  Commission  was  chartered.  In  its  year  book  fur  December  -'11.  191! 
the  Milk  L'ommission  says,  "l""or  eight  \  ear>  (since  19(i;!)  the  Milk  Com- 
mission for  Chicago  has  sitccessfully  carried  on  its  work." 

Chicago  Infaxt  A\'hlkai!e  Society. 

On  March  10,  1911,  the  Infant  Welfare  Society  was  foimed  li\'  a 
reorganization  of  the  Milk  Commission.  The  milk  stations  were  closecl 
and  the  new  organization  continued  the  policy  uf  instructing  mothers  in  the 
iiome  and  in  stations,  but  stressing  this  type  of  activit\    especialK  . 

Judge  Julian  Alack  resigned  as  president  Januarv  '■'>].  1911.  and  Mr. 
Lucius  Teter  succeeded  him.  Two  im|)ortant  conferences  with  represen- 
tatives of  the  Chicago  Medical  Society  are  referred  to  in  the  minutes. 
On  December  28,  1908,  a  joint  mei'ting  was  held  to  discuss  the  confusion 
which  seemed  to  be  arising  relative  to  the  use  of  the  terms  medical  com- 
mission, milk  and  certitiefl  milk,  commission  milk.  This  seems  to  have 
l:.een  adju>ted  by  having  the  Milk  Connnission  rccoinniend  some  persons 
to  membership  of  the  Milk  Certifying  L'ommission  of  the  Chicago  Medical 
Society. 

This  source  of  friction  was  cntii-ely  rcmo\ed  little  more  than  two 
years  later  when  the  Milk  Commission  changed  its  name  and  stopped  sup- 
[ilving  milk'. 


302  AUXILIARY    HEALTH    ACENCIES 

Another  consultation  willi  rc]>rcsfiitativcs  of  the  Chicago  Medical  So- 
ci(.-l\-  was  hclil  l'\;hru,ir\  '.'.  i:i<i!i.  This  was  will)  reference  to  the  system 
of  consultation  days  and  hours  for  mothers  and  habies.  The  plan  appears 
to  have  met  the  approval  of   the   representatives  of   the  medical  society. 

On  March  ]."),  ]li|(i.  a  joint  meeting  of  the  Milk  Commission  and  the 
Children's  Society  was  held  to  work  out  a  ])lan  for  infant  welfare  stations 
that   would  he   more  eomprelu'nsive  than   that   in  use. 

(  )n  March  ■.".•,  l!»l(l.  Dr.  W.  .\.  livaiis,  health  commissioner  of  Chi- 
cago asked  the  Milk  Commission  to  participate  in  a  city  wide  "Save  the 
Babies  Campaign"  during  the  .summer  of  1910.  This  campaign  was  to 
operate  through  infant  welfare  centers  as  agencies.  The  Society  accepted 
and  participated. 

In  Decemlier  llHt).  the  superintendent.  Miss  Ahrens.  made  a  report 
hast'd  on  a  four  months  study  of  the  local  situation.  She  recommended 
a  reorganization  of  the  w^ork  of  the  society  under  a  medical  director.  This 
was  done. 

The  final  transformation  of  the  Commission  into  the  Infant  Welfare 
Societv    in    I'.M  1    has   been   referred   to   aho\e. 

The  Society  has  functioned  since  on   that  basis. 

Its  objects  are  stated  as: — "To  reduce  the  infant  death  rate  and  im- 
prove the  health  of  the  coming  generation  by  keeping  the  baby  well,  before 
Its  biitli  bv  caring  for  the  mother  and  after  its  l)irth  by  teaching  her  how- 
to   feed   and   care   for  her  child." 

'I'lie  ty[)es  of  care  gi\en  in  I'.f.'ii  are  prenatal  care,  infant  care,  care 
of  pre-sch(  ol  children. 

The  number  of  infant  welfare  stations  operated  in  l!C2l!  was  given  as 
twenty-three.  <  )f  these  nine  stations  ga\e  all  three  kinds  of  work.  Seven 
gave  service  onl\  to  preschool  children.  Si.\  served  infants  only  and  one 
gixcs   prenatal  and   infant   care  only. 

In  llf.'Ci  ])renatal  care  was  given  to  1  .'JUS  mothers,  infant  service  was 
gi\ui  to  l''.!H)l   b:il)ies,  an<l  preschool  service  to  2,129  children. 

.\  pari  of  the  service  rendered  since  (  Ictober  1925  is  in  mental  hygiene. 

Kl.lZ.vr.K'PII     Mcl'oKMU'K     MkMOKLVL    Fdt'NDATIOX. 

The  ILIizabetb  .McCormick  .Memorial  I'oundation  specializes,  in  jiro- 
motiiig  health  work  among  cliildri'ii.  1  laving  observed  the  operation  of  open 
window  schools  in  the  (iraham  school  in  lIMis  and  1909  they  spent  several 
vears  in  active  propaganda   for   fresh  air  and  o|ien  window  schools. 

Thev  ne.xt  lucanie  active  in  jiropaganda  and  prcuiotiun  of  the  Emer- 
son plan  for  improving  the  nutrition  of  school  children.  More  recently 
thev  have  been  promoting  more  general  procedure's  ])rincipallv  aimed  at 
improving  the  nutrition  of  school  children. 


auxiliary  health  agencies  303 

Orgaxizatioxs  of  Professional.  Health  ATorkers. 

Since  the  time  of  Dr.  J-  H.  Ranch  there  has  always  been  one  or  more 
State  health  societies  in  the  State.  Most  of  the  times  these  societies  have 
been  paper  organizations.  At  times  they  have  functioned  satisfactorily. 
At  the  present  time  there  are  three  of  them.  The  health  officers  have  an 
organization  which  meets  annually  to  discuss  methods  of  doing  health  work — 
its  principal  function  is  to  promote  the  efficiency  of  health  officers  and  to 
better  the  work  of  prevention  done  by  them. 

The  Illinois  Tuberculosis  and  Public  Health  Association  has  some 
general  health  work  in  addition  to  their  tulierculosis  work.  They  hold 
an  annual  meeting  and  issue  a  periodical. 

The  Illinois  Health  Society  has  some  funds  in  the  treasury  and  main- 
tain an  organization. 


HEALTH  CONDITIONS  IN  ILLINOIS  AFTER  1877. 

Few  chanj,'es  in  the  history  of  illinoi>  have  heen  so  i)ronouiicc(l  as  the 
differences  between  lieaUh  con(htiiins  that  ])revailed  fifty  years  before  and 
fifty  years  after  b'-;;';.  I'rinr  to  that  date  tlie  territory  inchided  \viliiin  the 
boundary  hues  of  ilir  Stale  went  throULjh  a  ])erio<l  wiien  it  rii,dul\  provoked 
the  reputation  of  beint;  one  of  the  most  nnheahiifnl  ])orlion>  of  the  L'nited 
States.  I'racticaily  no  ini])ro\enK-nt  in  niortahty  and  siei<ness  rates  tooi< 
place  before  1877  althou,<,dT  malaria,  the  ])redominating  factor  in  the  early 
evil  reputation.  Iiad  begun  to  decline  noticeably.  Indeed  the  prevalence  of 
such  infections  as  iy])hoid  fever,  tuberculosis,  diphtheria  and  most  of  the 
otlier  c(.inimunicable  diseases  grew  worse.  The  fertility  of  the  soil  and  other 
economic  resources  such  as  coal  made  so  strong  an  a]ipeal  to  settler>  that 
immigration  poured  in  regardless  of  health  liazards.  It  was  true,  further- 
more, that  the  diseases  which  beset  humanity  in  Illinois  after  the  plague  of 
malaria  became  more  tolerable  were  common  everywhere  so  that  there  was 
no  point  in  avoiding  the  State  because  of  them. 

At  the  end  of  the  first  fifty  years  subsequent  to  \S]~,,  Illinois  enjo_\ed  the 
re])Utation  of  being  one  of  the  most  healthful  commonwealths  in  the  L'nited 
States.  Mortality  statistics  uphold  this  reputation.  While  many  factors 
are  present  that  ]irevent  mortality  statistics  from  portraying  an  absolutely 
accurate  picture  of  health  conditions  they  do,  nevertheless,  reveal  what  may 
be  accepted  as  ajiproximately  correct  information.  The  factors  present  in 
the  Illinois  statistics  are,  moreover,  to  be  reckoned  with  in  the  data  from 
every  other  State  so  that  comparisons  are  justified. 

The  mortality  records  iniblished  by  the  United  States  Bureau  of  Census 
give  lllinoi>  a  lower  death  rate  for  1!)'26  than  the  United  States  and  a  rate 
lower  than  an\  other  of  the  seven  states  with  an  estimated  population  of 
4, ()()(), <M)0  (ir  more.  I'nrlhermore.  the  a\'erage  annual  death  rate  in  Illinois 
for  the  six  years  ended  with  IM'.'ii  was  lower  than  the  average  for  any 
other  of  the  same  group  of  states   for  the  same  period.     The  figiu'es  are: 

MoKT.M.ITV  TEK  1,000  Pol'UL.VTION. 

(U.  S.  Bureau  of  the  Census.) 


states'. 

1921. 

1922. 

1923. 

1924. 

1925. 

1926. 

Average. 

Califonii-i 

13,2 

11  1 

12  2 
116 
12  .3 
11    3 
12-4 
11.6 

14. .1 

11  3 

12  8 
11    3 

13  0 
11.3 
12.3 
11.8 

14  3 

12  0 

13  .0 
12  4 
13.0 
12.3 
13.  3 
12  3 

14.  5 
11.2 
12. .0 
11. .6 
12.7 
11   2 
12.3 
11. -S 

13.6 

11  .5 

12  .5 
11.  ,") 
12  .8 
11. .4 
12   4 
11..7" 

13.6 
11.8 

12. 6 

12. 7 
13.4 
12.3 
12.7 
12.. 1« 

IllilK.is 

.MillliK^li 

11  5 

12  0 
11. S 

11   6 

12  5 

11   9 

'  With  4.000.000  o 
'  rrovisidiial    figu 


jitcd  iioimlation 


(304) 


HEALTH    CONDITIONS  AFTER    18TT  305 

Texas  comt-s  within  the  ])o]nilation  chissification  indicated  in  the  table 
hut  that  state  was  not  included  in  the  United  States  death  registration  area 
during  the  period  for  which  statistics  are  given. 

The  data  cited  show  that  health  conditions  in  Illinois  were  cciual  to  it 
not  hetter  than  those  which  prevailed  in  the  country  at  large  after  lli'-iO. 
Similar  statistics  for  earlier  jieriods  are  not  available  but  there  are  other 
evidences  of  a  profound  change  for  the  better  after  1877.  For  one  thing 
the  average  length  of  life  increased  very  noticeably.  Only  four  and  seven 
tenths  per  cent  of  all  deaths  recorded  in  1SS0  were  among  persons  over  75 
years  uld.  In  l!i"^5  the  percentage  was  tifteen  and  three  tenths.  In  actual 
numbers  the  deaths  among  the  older  than  75  age  group  went  u]i  from  2131 
in  1880  to  12,545  in  1925,  an  increase  of  nearly  six  fcjld  during  a  period 
when  the  total  population  only  doubled.  Furthermore,  deaths  among  chil- 
dren less  than  five  years  old  fell  from  about  forty-five  per  cent  of  all  mor- 
tality in  1880  to  about  fifteen  per  cent  in  li)25.  Again,  the  experience  of 
industrial  insurance  companies,  who  pay  more  regard  to  dollars  and  cents 
than  to  theories,  shows  an  increase  of  about  11  years  in  the  average  span 
of  life  of  policy  holders  between  l!)lii  and   l!)2(i. 

Another  evidence  of  increasing  longevity  is  the  greater  number  of  peo- 
ple who  cHe  from  old  age  diseases.  Heart  disease,  cancer,  nephritis  and 
cerebral  hemorrhage,  particularly  the  first  two,  caused  a  far  greater  per- 
centage of  deaths  in  1926  than  they  did  twenty,  fifty  or  one  hundred  years 
before.  In  1880  mortality  from  heart  disease  was  less  than  three  per  cent 
of  the  total  deaths  and  that  from  cancer  was  scarcely  more  than  one  per 
cent.  In  1925  heart  diseases  were  credited  with  more  than  seventeen  and 
cancer  with  more  than  eight  per  cent  of  the  total  mortality,  or  twenty-five 
percent  together.  This  is  clear  proof  that  people  live  longer  because  these 
diseases  are  insignificant  catises  of  death  for  people  under  forty. 

Then  there  is  the  seasonal  phenomenon  of  mortality.  All  statistics  ap- 
plving  to  death  rates  in  Illinois  prior  lo  l!"i()  show  unmistakably  that  the 
hot  months  were  the  most  liazard(.)us  for  life,  .\ugust  and  Septcml)er  were 
nearlv  always  the  months  of  heaviest  mortality.  .\bout  1900  a  gnidual 
transformation  became  noticeable.  1-ong  before  1921  August  and  Septem- 
ber had  become  the  period  of  lowest  morialily  and  the  time  when  people 
were  freest  from  sickness.  This  chan.ge  resulted  from  a  diminution  in  the 
I>revalence  of  such  diseases  as  cholera,  typhoid  fever,  diarrhea  and  other 
intestinal  disturbances. 

There  are  no  general  mortality  data  a\ailable  which  furnish  a  reliable 
basis  for  comparing  health  conditions  in  Illinois  during  the  various  |)eriods 
referred  to.  All  of  the  statistics  relating  to  the  State  as  a  whole  are  frag- 
mentary for  the  years  prior  to  1918.     Th.-ii  was  the  dale  when   Illinois  was 


SOfi  IIKAI.TII    CD.NIHTIONS    Al'TKU    1877 

ailniiltrd  to  tlu-  I'nitcd  Slates  death  re,t,dstrati(in  area,  a  manifestatinii  that 
iiiniialil\-  repdils  were  suflieieiitlv  edinplete  ti)  warrant  federal  reeiif^iiition. 
Before  that  date  they  had  ranged  front  sixty  to  eighty  per  cent  ineomplete. 
That  much  disere]>ancy  make  unreliable  any  conclusion  that  might  be  drawn 
from  general  mortality  rates  based  upon  the  published  records  of  death. 

With  all  of  their  inc(]nipleteiiess,  however,  the  statistics  for  specific  dis- 
eases iiroviile  \aluable  basis  for  conclusions  regarding  the  public  health. 
These  data,  together  with  inforni.ition  collected  from  other  sources,  iuniish 
material  for  tracing  the  trend  of  man's  con(|nest  of  disease  in  Illinois  and 
the  success  that  has  attended  his  eli'ort>.  This  is  set  forth  in  tln'  chapters 
that   follow. 

The  two  factors  which  contriiiUted  more  than  any  other  to  the  fall  of 
communicable  diseases  in  Illinois  after  bs7;  were  the  requirements  of  case 
reports  and  the  development  of  bacteriological  laboratory  service.  Quaran- 
tine and  the  isolation  of  patients  helped,  but  nowhere  in  the  wdiole  category 
of  infectious  ailments  was  progress  toward  eradication  so  pronounced  as 
it  was  with  those  diseases  for  which  laboratory  facilities  provided  aids  in 
diagnosis  and  specific  products  for  cure  or  prevention.  Alalaria  is  a  possible 
exception  and  in  this  case  the  great  change  in'environiuent  that  drove  out 
the  disease  might  be  thought  of  as  the  unconscious  operation  of  a  great 
sociological  laboratory.  Smallpox  is  perhaps  another  exce])tion  but  here  by 
a  happy  circumstance  of  clever  observation  man  was  able  to  employ  a  jiro- 
cedure  stripped  of  s|)ecihc  bacteriological  information  which  in  relation  to 
another  disease  would  have  waited  for  the  results  of  laboratory  research. 

Tuberculosis,  typhoid  fever  and  diphtheria  are  the  three  diseases  against 
which  the  luost  phenomenal  progress  toward  eradication  w^as  made.  The 
marked  receding  prevalence  of  each  set  in  after  the  introduction  of  labor- 
atory^ service  concerning  each.  Toward  the  end  of  the  period  covere<l  by 
this  volume,  the  laljoratory  developed  facilities  helpful  in  controlling  scarlet 
fever  and  jiiieumonia.  Time  had  not  periuitted  any  considerable  results 
from  these  processes  although  scarlet  fever  had  already  responded  indirectly 
to  laboratory  procedures  in  that  milk  supplies  were  subjected  to  sanitation 
thereby. 

\  encreal  diseases  can  be  diagnosed  in  lalioratories  and  that  fact  con- 
tributed enormously  to  such  success  as  attended  the  efforts  of  control  but 
the  peculiar  sociological  connection  of  these  diseases  ])revented  their  decline 
in  degrees  characteristic  of  some  others. 

No  infectious  disease  endemic  in  Illinois,  again  with  the  exception  of 
malaria,  declined  to  any  signihcant  degree  until  health  antlmrities  i-e(|uired 
the  notification  of  cases  and  develojied  machinery  for  enforcing  the  reijuire- 


HEALTH   CONDITION'S  AFTER    1S7T  307 

ment.     Knowledge  of  location  of  cases  ])erniilte(l  the  applicatii)n  of  all  the 
ciintrcil  measures  available  to  health  officers. 

In  the  summer  of  192?  a  general  revision  of  the  rules  and  regulations 
relating  to  communicable  diseases  was  made  by  the  State  Department  of 
Public  Health.  A  more  general  de])endeiice  on  laboratory  procedures,  a 
more  rigid  requirement  of  case  reports  and  a  substitution  of  indeterminate 
for  specific  long-time  quarantine  periods  featured  the  revision.  Results  r)f 
laboratory  examination  of  specimens  and  clinical  evidence  were  the  factors 
specified  to  determine  length  of  isolation  rather  than  dependence  on  an  arbi- 
trary time  period. 

Smallpox  and  Vaccination. 

Smallpox  is  a  disease  for  which  preventive  measures,  such  as  vaccina- 
tion and  revaccination,  isolation  of  cases  and  the  ob.servation  and  quarantine 
of  susceptible  persons  who  have  come  in  contact  with  a  case,  are  absolutely 
effective.  The  usefulness  of  these  measures  was  generally  recognized  by 
sanitarians  when  the  State  Board  of  Meallh  was  organized  in  ISTI.  but  ])ub- 
lic  ojiinion  had  not  been  awakened  to  the  necessity  of  carrying  out  these 
simple  [irocedures.  As  a  result,  vaccination  was  neglected,  and  local  au- 
thorities, upon  whom  falls  the  responsibility  for  the  enforcement  of  i)ul}lic 
health  regulations  in  this  State,  were  often  negligent  in  carrying  out  the 
oilier  preventive  measures  referred  to  above,  such  as  isolation  and  (juaran- 
tine,  e\rn  in  the  presence  of  a  local  outlireak.  'I'his  was  the  state  of  affairs 
when  the  Hoard  was  organized  in  is;;,  but  it  did  not  long  remain  that  way, 
for  in  ISSI  to  1882  there  occurred  an  epidemic  of  smallpox  of  such  iiropor- 
tions  that  the  entire  State  was  roused  to  action,  so  that  it  Ijecame  relatively 
easy  for  the  .State  Board  to  enforce  general  vaccination. 

Bui  in  time,  especially  when  a  feeling  of  trani|uility  began  to  iprevail 
on  account  of  the  relative  al>sence  ot  -mallpox,  these  measures  were  neg- 
lected and  later  even  attacked  in  the  courts  w  itli  the  usual  result,  that  con-, 
ditions  soon  1)ecame  rijie  again  tor  another  oullireak. 

The  history  of  smallpox  in  the  Slate  is  ^raphicallv  shown  \)\  the  chart 
in  iMi^m-e  IN-A.  which  shows  the  course  of  the  disea>e  from  ISiiil  in  d.ite.  as 
indicated  by  the  decennial  or  animal  mortality  rales  as  far  as  these  are  avail- 
able. 

Hninllpox  Not  Preraloit. 

Smallpox,  not  being  especialK-  pie\aleiil  during  the  first  two  \ears  of 
the  Board's  existence,  did  not  demand  any  special  attention.  L'ondilions 
soon  changed,  however.  Immigration  into  llu-  State  from  liurope  was 
heavy.     The  population  was  umaccinaled.     The  apjiearaiice  of  an  e]iideinic 


308 


IIILALTII    COXDITIOXS   AKTEK    1ST' 


was  only  a  niallrr  nf  time.     This  time  arrived  about    1880.      P.y    1.^81    tlie 
situation  was  eom])le;ely  beyond  control.     Small]>ox  was  rampant. 

General  conditions  as  well  as  tho.se  in  the  State  were  grave  enougli  to 
lead  Dr.  |ohn  11.  Kancli.  .Secretary  of  the  State  Board  of  Health,  to  take 
it  upon  hiinsclt'  to  call  a  .t;eiieral  conference  to  be  held  in  Chicago  on  June 
29-;iO,  18SI,  to  consider  the  smallpox  situation.  In  answer  to  his  call  18 
health  organizations  from  14  different  states  responded.  The  federal  gov- 
ernment was  represented  by  members  of  the  National  Board  of  Health, 
an  organization  that  was  in  existence  at  that  time.     The  meeting  was  held 


SMALLPOX 

in  ILLINOIS 
1860-1926 


STATISTICS   UNAVAILABLE    FOR  OPEfl    YEARS 


at  the  a|i])ointe(l  time,  and  after  full  delilieiation,  the  Conference  recom- 
mended that  Cull!.; less  incorporate  into  the  laws  regulating  immigration,  a 
provision  reciuiring  protection  from  smallpox  by  successful  vaccination  of 
all  immigrants,  also  that  the  National  Board  of  Health  consider  the  pro])riety 
of  re(iuiring  the  ins]iection  of  iinmigrants  at  ])orts  of  departure,  the  \accina- 
tion  of  those  unprotected,  and  the  deteiiiion  of  ;d]  unprotected  |>ersons  who 
hatl  been  exposed;  that  measures  be  taken  fur  ihi-  (|uarantine,  by  the  deten- 
tion of  all  steamships  bringing  immigrants  nut  pi(i\ideil  with  proper  evidence 


HEALTH   CONDITIONS  AFTER    18T7 


309 


of  vaccinal  protection  ;  that  local  health  authorities  also  inspect  all  immigrants 
arriving  in  their  respective  jurisdiction  and  enforce  proper  protective  and 
preventive  measures  when  necessary,  and  that  the  National  Board  of  Health 
take  steps  to  secure  the  inspection  of  all  immigrants  and  the  vaccination  of 
the  unprotected  hefore  landing  them  at  any  jiort  in  the  United  States.  A 
considerahle  part  of  this  program  was  carried  out  later.  An  immigrant  in- 
spection service,  fnr  instance,  was  established  in  the  United  States  for 
the  six  months  of  July  U>  December  ISS-^.  Physicians  were  posted  at  rail- 
way terminals  thniughi  ut  the  country.  Dr.  Raucli  was  superintendent  for 
the  Western  District  and  caused  the  insiiecliun  nl'  115.057  and  the  vaccina- 
tion of  21,618  immigrants  bound  for  Illinois.  This  wi)rk  was  done  largely 
at  Chicago  and  St.  Louis,  the  railway  terminals  leading  into  the  State. 

Table  25. 


c 

ASEs  OF  Smallpox  Reported  in 

Illinois. 

Year. 

.Jan. 

Feb. 

Mar. 

Apr. 

Ma.v 

June 

1 
Jul.v      Aug. 

Sei  t. 

Oct. 

Nov. 

Dec. 

Total. 

1917 

1 

S56 

910 

526 

657 

811 

411 

312 

114 

148 

168 

93 

292 

4,996 

1918 

742 

744 

645 

557 

571 

189 

103 

73 

26 

42 

36 

114 

3,842 

1919 

322 

284 

465 

567 

5-4 

442 

183 

135 

232 

260 

648 

779 

4,871 

1920 

776 

842 

748 

1,063 

1,232 

909 

383 

212 

198 

326 

553 

1,294 

8,536 

1921 

1,900 

1,659 

1,760 

1,204 

1,027 

412 

102 

29 

23 

39 

120 

261 

8,536 

1922 

3,3 

360 

228 

197 

238 

115 

175 

40 

8 

75 

176 

133 

2,118 

1923 

369 

121 

64 

50 

69 

128 

39 

24 

9 

28 

15 

21 

937 

1924 

37 

46 

95 

HI 

164 

242 

168 

46 

42 

187 

58 

166 

1,362 

1925 

210 

299 

220 

215 

150 

194 

46 

30 

20 

30 

79 

137 

1,630 

1926 

177 

164 

108 

165 

135 

105 

93 

21 

26 

5 

25 

51 

1,077 

1927 

172 

118 

213 

113 

150 

63 

67 

1 

1 ' 

Oiifhreal-  nf  1SS1  and  18S2. 

The  a\-eraj.;e  pre\alence  of  sniallp(.)x  during  the  _\ears  1S7T  to  ISSO  was 
relati\ely  lew,  but  early  in  ISSl  it  began  to  increase,  and  by  the  mil  (if  the 
year  a  tcjtal  of  :i.(iOO  cases  was  reported,  of  which  nunilier  l.lso  dccurred 
in  Chicago. 

At  a  special  meeting  of  the  .^tate  Board  of  Health,  in  November  l.SS], 
the  notihcatinn  uf  smallpox  or  other  epidemic  disease  was  made  compulsory. 
Local  health  officers  were  required  to  collect  the  rep(jrts  from  practicing  ])hy- 
sicians  and  transmit  them  |)rnnii)tly  to  the  Board.  It  cannot  be  said,  how- 
ever, that  either  cases  or  deaths  were  reported  with  any  large  degree  of 
completeness  because  no  machinery  for  collecting  reports  existed.  There 
were  very  few  local  health  officers. 

The  situation  was  serious  and  re(|iiired  vigorous  action.  Recognizing 
school  children  as  a  large  section  of  the  population   which  coujd  easily  lie 


310 


IIMAI.III    CO.NDITIOXS  AFTKK    1ST7 


reached  with  the  least  etitirt  and  in  the  <|uickest  time,  the  Board  ordered 
that  no  child  be  admitted  to  ]nil)lic  scimuls  in  the  State  after  January  1  with- 
f)nt  .yiNinij  evidence  of  successful  \accinaliun  or  a  histor\-  of  >inanpox. 

The  plan  worked.  Within  sixlv  days  aftt'r  the  order  went  into  effect 
the  percentasie  of  \accinalcd  school  children  rose  from  al)out  l-"i  to  !i  I  jjer 
ci'nt.  A  consideralilc  inimlier  of  adtills,  particularly  t-mployees  of  lar^e  in- 
dnstrics  like  the  railway  companies  and  inniatt-s  of  State  institutions  were 
als<i  \accinated.  Th"  epidemic  snhsided.  The  peo])le  became  absorbed  in 
other  problems  and  promptly  forgot  all  about  the  com])ulsory  vaccination 
order  an<l  ignored  it  although  the  Hoard  had  put  it  into  effect  as  a  permanent 
jirocedure. 

Eyents  ran  true  to  form  so  that  in  the  course  of  time  neglect  of  vaccina- 
tion resulted  in  widespread  outbreaks  of  smallpox  again  as  soon  as  the  m- 


Talile  2(!. 
Deaths  from  Smalli'dx  in  Illinois  by  Months. 


1             ! 
Year.       I    .Jan.       Feb. 

i              1 

Mar. 

A,-r. 

May. 

June. 

Jul.v. 

Aug. 

Sept, 

1 
Oct.       Nov.   1  Dec. 

Total. 

I9I7 

1 

1 
1   

i 

i              1 
1 1 

10 

1918 

4 

1 
1 
4 

1 
1 
2 
2 
5 

4 

2 

■"i"' 

6 

3 
1 

1 

1 

1 

2 

14 

1919 

5 

1920 

1 
4 
I 

1 
4 

1        

2 

1 
2 

3 

5 

16 
26 

23 

1923 

I 

2 

1 



■■■^■■■ 

2 
2 

6 
2 
3 

2 
6 
2 

2 

1 

16 

I 

23 

1926         1       I 

1 



8 

fluence  of  the  wholesale  \accinations  of  ISS'i  began  to  wane.  In  the  early 
nineties  the  situation  had  again  grown  serious  and  again  the  Board  altem])ted 
to  handle  the  matter  bv  demanding  compnlsorv-  vaccination  of  school  children. 
This  time  the  outcome  was  not  so  happ\-  for  sanitarians,  luiough  pu])ils  were 
vaccinated  to  check  the  epidemic  but  Iwo  law  suits  were  started  bv  parents 
who  objected  to  the  coerci\e  character  of  the  \  accination  procedure.  (Jne 
against  a  school  board  in  \\a\iie  C  ount\  wa^  drop|ied  b\-  the  defendants. 
The  members  of  the  sclinol  Ixiard  had  been  lined  bv  a  justice  of  the  peace 
and  appealed  at  twii  dillerent  times.  Both  suits  were  dropped,  howxwer.  up- 
on advice  of  the  local  state's  attornev  who  opined  that  a  reversal  of  decision 
was  improbable. 

.\    m.andanius    suit    was    started    in    Lawrence    C'onnl\'    against    a    school 
board,   to  compel   it  to  admit   the   children   excluded    from   the   schools   be- 


HEALTH    CON'DITIOXS  AFTER    18T7  311 

cause  they  were  not  vaccinated.  The  case  was  first  decided  against  the 
school  board.  The  decision  was  affirmed  liv  the  circuit  court  of  Lawrence 
County,  and  appealed  to  the  apiiellate  court.  It  was  then  taken  to  the 
Supreme  Court,  which  rendered  a  decision  against  the  school  board  in  No- 
vember, 1895.  This  decision  declared  unconstitutional  the  requirements  of 
vaccination  as  a  contingent  to  attendance  on  public  school  so  that  the  rule 
of  the  Board  was  voided.  The  subsequent  ]iractice.  which  has  been  upheld 
by  the  courts,  has  been  to  recjuire  either  vaccination  or  quarantine  of  all 
school  children  during  the  period  of  immediate  danger  after  smallpox  has 
actually  appeared  in  a  conuiiunit}-. 

Table  27. 
Deaths  and  De.ath   Rates  from   Smallpox  in   Illinois. 

Riite  per  Rate  per 

100,000  100.000 

Year.  No.  lieatlis.       pii|nilation.  Year.  No.  deaths,       population. 

1850 

1860   


1882  2,641 

1883  103 

1884  U 

1885  63 

1890  

1900  -..  25 

1902  67 

1903  --..- 135 

1904  - 242 

1905  131 

1906  2 

1907  5 

1908  - 1 


By  an  act  of  the  legislature,  in  force  Julv  1,  IS'.i.j.  it  was  mack-  tlu-  duty 
of  the  tnistees  of  the  Uni\ersitv  of  Illinois  to  establish  and  maintain  a  State 
vaccine  propagation  station.  The  law  also  provided  that  the  State  Board  of 
Health  should  exercise  supervision  of  the  methods  of  propagation  and  cer- 
tify to  the  purity  of  all  products  manufactured  at  this  plant.  An  appropria- 
tion ol  $.'?.(ll)(l  was  made  to  establish  and  maintain  the  vaccine  farm  in  con- 
iH-ction  with  the  State  University.     This  pruject   was  short  lived,  however. 

.Ml  the  troops  sent  from  Illinois  for  dutv  (luring  the  S]>anish-.\nierican 
War  in  1S!),S  were  vaccin.-iled  against  smallpox  ihrough  tin-  acti\it\'  of  the 
State  Hoard  of  Health. 


1909  

1910  .. 

8 

8 

0  14 

0.4 

0.14 

6.7 

mil  .. 

8 

0.13 

1.4 

1!I12  . 

12 

0.20 

54,6 

1913  

3 

0.05 

Sl.S 

1914  

20 

0.03 

3.1 

1915  

5 

0.08 

.32 

1916  

6 

0.09 

1.8 

1917  -  - 

10 

0.02 

191S  

14 

0.23 

.51 

1919  ... 

0.08 

1  3 

1920  ... 

16 

0.23 

2  6 

1921  ... 

26 

0.37 

4  7 

1922  ... 

23 

0.34 

2  5 

1923  ... 

2 

0.03 

0.03 

1924  .... 

16 

0.23 

0  09 

1925  

23 

0.31 

0.02 

1926  -.- 

8 

0.11 

312  TIF.AI.TII    COXDITIOXS   Al'Tl.k    ISTT 

Smallpox  in  19UH  and  After. 

In  1903,  a  total  of  1,6G1  cast-s  of  smallpox  were  rrpuili-d  and  it  was 
estimatc'<l  liy  tlu-  Board  that  this  number  rejjrcsentcd  pnil)alil\'  ikiI  over 
two-thirds  of  tlu-  cases  occurring-  in  the  State. 

Another  law  suit  .^rcw  o\\\  of  a  smallpox  epidemic  at  Hyde  Park,  Chi- 
cago in  llMi;.  'rhi>  inviihcd  a  cit\-  ordinance  which  required  vaccination 
as  a  contingent  upon  school  attendance.  Here  again  the  Supreme  Court  de- 
cided in  fa\iir  of  the  plaintitf,  holding  that  neillier  local  health  ollicers 
nor  cities  had  the  authorilv  to  make  or  enforce  such  oi^dinances. 

Thus  it  was  made  very  clear  that  compulsory  vaccination  w^ould  not  be 
tolerated  in  Illinois  under  prevailing  laws.  It  was  up  to  health  officials  to 
fnid  some  other  wa\'  to  control  smallpox. 

This  situation  resulted  in  the  practice  of  requiring  either  vaccination  or 
(|uarantine  of  exposed  persons  in  a  conimunit\  where  smallpox  was  actually 
present.  The  courts  have  generallv  uplield  this  procedtu'e.  It  is  still  in 
vogue  and  operates  fairh-  satisfactorilv  when  the  .^tate  health  officials  are 
alert.  Practically  ever^nne  in  a  comnnuiitv  ma\'  l)e  regarded  as  exposed 
to  ^mall])ox  when  the  disease  is  |iresent  so  that  the  method  jjractically 
amounts  to  com])ulsory  vaccination  on  the  installment  plan,  the  nistallments 
coming  due  when  epidemics  threaten. 

Since  190.J  smallpox  has  Huctnated  with  the  \eais,  \ar\ing  with  the  de- 
gree of  .success  that  attended  \arioirs  schemes  for  stinnilating  \accination. 
In  general  the  disease  has  been  mild  although  m.alignant  cases  were  intro- 
duced into  Illinois  in  lie.'".'  and  again  in  111'.' I.  Mortalitv  has  steadfastly 
remained  below  one  death  ])er   loo.ooo  peoi)le,  howe\er,  dm'ing  the  period. 

The  last  significant  ste]i  toward  jirevenling  smallpox  in  Illinois  was 
taken  in  l!i'21  when  the  State  Department  of  Public  Health  imder  Dr.  Isaac 
IX  Rawdings  began  the  practice  of  making  a  personal  investigation  of  every 
reported  case  of  smallpo.x  and  everv  reported  case  of  chickenpox  in  adults. 
Field  physicians  are  assigned  to  these  duties  as  they  arise  from  time  to  time 
so  that  the  control  methods  described  aliove  can  be  applied  ])rompllv  and  ef- 
fectively. 

.State  and  local  ln'altb  offici-rs  have  indulged  in  sporadic  campaigns  agi- 
tating voluntary  vaccination  ,inil  these  efforts  result  in  considerable  success. 

P)y  combining  the  last  three  methods  mentioned  the  he.ilth  officials  have 
been  able  to  m.inage  smallpox  aliout  as  satisfactoril)'  as  could  be  expected 
under  existing  conditions.  .\o  alarming  outbreaks  developed  Uj)  to  this 
writing  subse(|uent  to  \'.)'i\. 


HEALTH   CONDITION'S  AFTER   187  T 


.313 


History  of  the  Chicago  Smallpox  Epidemic  of  189;1,  1894  and  181)5 
With  Side  Lights  and  Eecollections. 

[Bi/   Arthur  R.    KriiiioMs-,  M.   £».*] 

A  serious  epidemic  of  snialljiox  occurred  in  Chicago  during  the  years 
1S'.)3.  1894  and  1895.  Not  the  most  serious  in  the  city's  history,  for  three 
great  epidemics  had  previously  occurred,  one  in  ISCl,  another  in  18T2  and 
a  third  in  1SS2.  All  were  much  nnjre  serious 
than  that  of  1893-1S9").  Each  had  more  cases 
C(inii)ared  with  the  population,  all  were  more  fatal 
and  nunc  of  them  were  so  speedily  suppressed. 
During  the  ])revalence  of  smallpox  in  1880,  1881 
and  1882,  a  total  of  (i,835  cases  were  reported.  In 
the  1893-1895  epidemic  the  cases  numhercd  3,754 
in  a  population  more  than  three  times  greater 
than  ill  the  early  eighties. 

There   was   no   smallpox  in   Chicago   during 

1890  and  1S91.     In  the  following  year  eight  cases 

were  reported,  two  in  May,  one  in  June,  three  in 

Se])temher  and   four  in   December.      Concerning 

these  the  chief  medical  inspector.  Dr.  Garrott.  in  h\^  annual  report,  wrote 

"We  were  ahle  in  every  instance  to  trace  the  source  of  contagion  to  other 


Oi/srt  of  Epi/Iiiiiir  and  Varciiiatidii. 

In  January,  1S93.  there  were  three  cases  fi)lli)wed  liy  three  in  I'^ehruary 
and  live  in  Aijril.  The  onset  of  the  epiilemic  of  1S!)3-1S1)5  has  ordinarily 
been  given  as  June  12,  1893,  because  from  that  time  un  there  w;is  a  contin- 
uous monthly  occurrence  of  cases.  Undoubtedly  the  disease  had  been 
smouldering  for  two  years  previously  in  the  form  of  unrecognized  cases  for 
on  July  6,  cases  w-ere  found  in  three  widely  separated  localities  and  none 
could  be  traced  to  their  origin.  In  .\ugust  there  were  nine  cases,  in  Septem- 
ber three,  October  nine,  November  thirty-five  and  in  December  sixty-six. 

It  was  the  year  of  the  World's  Fair.  Throughout  189g  the  b'air  was  in 
course  of  Iniilding.  Thousands  of  workmen  and  others  came  to  the  city 
and  (if  course  they  brought  whatever  contagion  they  had  with  them.  Ex- 
hibitors and  others  from  every  country  were  coming  for  a  year  liefore  the 
Fair  opened  in  1893.  Indeed  the  formal  opening  of  the  h'air  was  in  ( )ctober, 
1892.  It  is,  fair  to  assume  that  smallpox  was  one  of  lln'  things  the  Fair 
brought  to  Chicago. 

•  Dr.  Arthur  R.  Reynolds  vva.s  appointed  Conimis.sioner  of  Health  for  Chicago  by 
the  elder  Mayor  Carter  H.  Harriwm,  .April  17,  lS(i:!,  and  served  until  .lune  13,  1SS5. 
He  was  aRain  ai)pointed  by  Carter  H.  Harris. ni.  .!r..  April  1 M.  1S!i7.  and  reappointed 
every  two  years  until  ,Iune  27,   IftO.";. 


31-1  nicAi.iii  KiMinioxs  after  18TT 

There  had  hucn  ,t;rcat  iic.l;1<.-cI  of  vaccinaticm  fcir  K)  years  previously.  In 
the  last  six  months  of  IS!i;i  nearly  one  hundnd  thousand  vaccinations  were 
done  bv  the  department  and  that  was  more  than  had  been  done  in  several 
years  l)efore,  all  told.  Mranwhile  every  means  that  the  department  could 
devise  was  employed  lo  arou>c  the  ])uhlic  to  the  necessity  of  vaccination. 
Letters  were  written  to  the  Miptrintendents  of  public  schools,  to  the  parochial 
schools,  to  private  schools,  to  the  head  of  btisiness  concerns,  factories,  the 
railroads,  etc.,  ur^int;  that  they  see  lo  it  that  those  whom  they  em])loyed  or 
were  under  their  control  wvvv  \accinated.  h'roni  all  came  hearty  responses 
and  pnmiises  of  cooprratii  in.  In  newspaper  inter\ie\\  s  the  necessity  for 
vaccination  was  constantly  stressed.  The  foreiijn  lani^nage  press  was  a])- 
pealed  to  and  innumerable  local  publications  were  also  addressed  and  from 
all  valuable  help  and  cooperation  was  obtained. 

By  January  1,  1894,  the  public  was  thoroui^hly  aroused.  livery  jihy- 
sician  in  the  city  was  vaccinating;.  This  valuable  start  was  m;i(le  without 
any  increased  expense  to  the  department  cxcejit  for  the  vaccine  that  was 
distributed  free  to  all  who  would  use  it. 

The  covtntry  was  in  a  period  of  ^reat  llnancial  stringency  Repeated  re- 
quests for  a])propriations  of  money  br(.night  no  results.  I'inally  the  mayor 
told  me  to  cut  loose  and  do  whatever  was  necessary.  It  was  realized  that 
the  entire  cit\'  nnist  be  vaccinated  immediately.  Several  hundred  physi- 
cians and  senior  medical  students  were  employed  to  vaccinate.  The  city 
was  divided  into  districts  and  those  again  into  sub-districts  and  men  put  to 
work  until  the  entire  cit\-  was  covered  by  \'accinators  who  went  from  house 
to  house  and  from  group  to  gmu]).  h'ive  hundred  were  employed  at  one 
time  and  more  than  half  a  million  vaccinations  were  done  in  three  or  four 
months. 

.\mong  this  ccn'ps  of  vaccinators  were  some  of  the  city's  ablest  medical 
men,  others  who  later  became  ]jrominent  practitioners.  Dr.  |iihn  Dill  Rob- 
ertson was  a  vaccinator  for  the  department  in  1894.  In  llil.">  he  became 
ce-mmissioner  of  health  for  Chicago  and  held  the  office  seven  years  with  a 
good  record.  He  is  still  ])rouil  of  having  been  a  vaccinator  for  the  depart- 
ment in  bis  early  career. 

Later  the  city  council  a|)propiiated  $l()(),(ll)()  but  a  rough  estimate  of  ex- 
peiidilurt'S  revealed  that  the  enlire  sum  had  l)een  sjient  or  contracted  for 
when  ihe  a|)iiropriation   was  made. 

Prcif/rcss,  II (isjiitu'iintniii  aii'l  Oilier  / iiciilnifs. 

.\n  emergency  hospital  was  ert-cted  and  soon  beds  were  available  for 
everN-  patient  and  thereafter  every  case  was  hospitalized.  Ly  May,  1S94. 
the  backbone  of  the  epidi'mic  was  broken,     b'rom  then  on  there  was  a  dimin- 


HEALTH    COXDITIO.XS   AFTER    l!ST^  315 

ishing  number  of  cases  each  nKintli.  The  last  case  Dccurred  in  December, 
1895. 

It  must  nut  be  jjresumed  tbere  was  no  faultfindint;  nr  criticism  nf  tlie 
(iepartmciit  and  its  head.  There  was  jjlenty  of  it  and  it  was  persistent  but 
we  knew  that  we  were  on  the  right  road  and  tliat  the  pubHc  as  a  whole  were 
with  us  and  stood  firmly  behind  us.  There  was  in  fact  great  apprehension 
in  the  city  as  there  always  is  in  time  of  peril,  but  it  ha<l  to  be  faced. 

The  department  was  fortunate  in  gathering  together  a  force  of  men 
who  knew  no  hours  but  worked  unceasingly,  who  did  as  much  as  the  com- 
missioner and  other  otlicers.  They  all  worked  as  partners  in  the  enterprise. 
Among  these  nnist  be  mentioned  the  late  Dr.  b'rank  W.  Keillv  who  was 
appointed  assistant  commissioner  in  January,  IMM.  to  whom  1  give  all 
praise  for  wise  guidance  throughout  the  rest  of  ni\'  ser\ice  which  ended  in 
June,  1905.  Credit  is  also  due  to  the  late  Dr.  Erasnnis  (iarrott  an<l  the  late 
Dr.  Heman  Spalding. 

The  late  John  P.  Hopkins,  then  Mayor,  stood  like  a  rock  behind  us. 
In  no  way  did  he  interfere  witli  the  selection  of  the  force  of  employees. 
He  attended  every  meeting  when  requested  and  there  were  manv  of  them. 
They  were  called  to  fliscuss  features  of  the  work  when  it  seemed  to  clash 
with  xime  interest  or  another. 

Hon.  .Martin  ]!.  Madden  was  then  an  alderman  and  chairman  of  the 
finance  committee  of  the  city  council,  he  had  great  courage  and  furnished 
a  wise  balance  in  many  a  cl.ash.  1  le  then  largely  controlled  the  city's  finances, 
held  a  firm  hanil  over  them  but  was  generous  as  could  be  expected.  For 
many  years  he  has  been  in  the  Congress  of  the  United  States  where  he  now 
keeps  a  wise  and  restraining  hand  upon  National  expenditure. 

The  details  of  the  epidemic  are  told  in  the  reports  of  the  department  and 
need  not  here  be  recounted.  There  are,  however,  manv  side  lights  of  that 
time  remaining  in  my  memory  that  may  be  told. 

In  lS'.):i  the  appropriation  of  money  for  the  department  of  health  was 
only  about  one-tenth  of  the  amount  in  recent  years  when  compared  on  a  per 
capita  basis  of  population.  There  were  S-t  peojile  all  told  employed  in  the 
department:  44  of  these  were  connected  with  smtike,  tenement  house  and 
factory  inspection,  10  weie  meat  inspectors,  10  fumigators,  8  medical  in- 
spectors and  4  were  funeral  directors.  From  the  distribution  of  these  assign- 
ments to  various  duties  may  be  seen  the  status  of  public  health  work  and 
disease  prevention  in  the  jniblic  mind  of  tli.at  time.  Sewer  gas  was  the  great 
bugbear  to  be  combated,  although  venti'ation  ami  cleanliness  of  homes  were 
always  stressed.  Ten  fumigators  fumigated  infected  rooms  or  houses  by 
burning  sulphur  after  sealing  up  all  cracks  about  windows  or  doors.  .After 
24  hours  the  windows  and  doors  were  opened  and  instructions  given  for  a 
thorough  scrubbing  of  the  floors  and  a  general  house-cleaning. 


316  lUCAI.TIl    fOMHTIOXS   AI-TKR    1877 

Contagious  diseases  were  reijorled  Ijv  physicians  in  a  rather  desuhory 
way  and  warning  cards  were  placed  on  the  front  door  of  houses  where  the 
disease  was  present.  An  investigation  of  the  fate  of  these  warning  cards 
revealed  that  they  were  sunu'tiines  laki-n  from  the  front  door  and  tacked  up 
on  the  hasenient  duor  wiiere  thev  could  not  be  seen,  .\nother  trick  was  to 
take  the  card  frmn  the  fnmt  diKir  and  ]jlace  it  (}n  the  back  door.  Another 
was  to  taki'  it  from  the  otitside  (li  the  dcxjr  and  put  it  on  the  inside  of  the 
same  door  and  \erv  frei|iientl\-  they  were  destroyed  altogether.  The  de- 
p.-irtnicnt  of  health  was  generalh'  considered  the  fifth  wheel  of  the  munici- 
pal iharidt.  The  ])resent  (la\'  elticienc\'  and  standing  of  jiulilic  health  wurk 
had  not  even  dawned  when  the  city  council  made  the  appro])riation  Inr 
is'.t.'i.  i'.efore  the  year  was  (Uit  and  the  pul)lic  awakening  was  nu.  it  was 
fretjuently  pointed  out  to  the  commissioner  of  health  that  he  had  the  power 
to  command  the  entire  resources  of  the  city  if  necessary  to  control  smallpox. 

The  inadequate  smallpox  hospital  was  soon  overcrowded.  Walled  and 
floored,  tents  heated  and  fully  equijiped  were  set  up  in  the  rather  spacious 
hospital  groimds,  but  soon  these  were  tilled.  .\  new  teni])orary  hos])ital  was 
quicklv  built  and  equipped  with  an  am])le  supply  nf  tents  f(ir  summer  use, 
and  from  that  time  on  there  were  beds  for  all.  The  new  hospital  was  not 
ready  until  the  time  when  the  new  cases  came  in  decreasing  numbers. 

When  the  smallpox  hospital  became  crowded  there  was  puldic  clamour 
demanding  that  another  building  be  fitted  U]i  for  teniiiorary  use  as  a  hos- 
pital. .A  school  building  was  suggested  and  a  public  meeting  was  held  in  the 
rooms  of  the  Board  of  Education.  .\  discussion  jiro  and  con  was  ha<l. 
Tliose  in  the  neighborhood  of  the  school  objected,  and  some  one  said  the 
building  was  too  good  for  such  purpose.  The  late  Mr.  Thomas  Brennan. 
presiding,  answered:  "Xo  building  w;is  too  good  for  the  care  of  the  sick." 
But  it  was  soon  found  that  the  idea  was  not  ])racticable  for  several  reasons, 
the  chief  of  which  was  that  the  relitting  would  be  too  expensive. 

Mrs.  Dudley,  wife  of  Dr.  \\.  C  Dudley  of  Chicago,  was  then  at  the 
be.id  of  the  N'isiting  Nurse  .\ssoci,ation.  She  came  and  offered  to  furnish 
the  nurses  for  the  new  hospital  and  pay  their  salaries.  The  otf'er  w,as 
promptly  accepted.  The  nurses  were  retained  until  the  hospital  closed  in 
1895  and  after  that  the  city  paid  the  salaries  of  the  nurses. 

Smallpox  was  prev.alent  in  a  section  of  Chicago  where  there  were  fac- 
tories for  read\-  made  clothing.  .\t  a  meeting  of  the  clothiers  it  was  sug- 
gested tb.it  clothing  ship]ie(l  shouM  h:i\e  a  label  saying  the  goods  were  free 
from  smallpox  cont.agion.  Dr.  Reilly  at  once  protested  that  such  a  lal.iel 
cast  suspicion  on  the  goods  and  would  be  ruinous  to  the  trade.  It  was 
.announced  th.at  no  infected  goods  of  any  kind  would  be  shipped  from  Chi- 
cago or  sent  to  any  place  within  the  city. 


HEALTH    CONDITIONS   AFTER    18TT  3IT 

At  another  meeting  of  the  clothing  industry  a  representative  of  the 
State  demanded  that  the  department  of  health  burn  all  clothing  that  had 
been  in  the  hands  of  home  workers  where  there  might  be  contagion.  The 
dei)artment  of  health  agreed  to  burn  everything  that  the  State  recommended 
for  such  fate,  provided  the  State  guaranteed  to  indemnify  the  owners  for 
anv  unnecessary  loss  that  subsequently  might  be  proven.  '1  hat  ended  that. 
There  was  much  speculation  on  the  danger  of  infection  in  the  factories 
of  the  ready-made  clothing  industry  and  several  meetings  of  those  interested 
were  held.  At  one  of  these  meetings  at  which  Mayor  Ho])kins  was  present 
Mr.  Hart  of  Hart.  Shat?ner  &  Marx  offered  to  raise  $5,000  and  present 
it  to  the  city  to  battle  the  contagion.  After  the  meeting  the  Mayor  was 
asked  what  he  tlu)ught  of  Mr.  Hart's  offer.  He  answered,  "The  city  cannot 
afford  to  accept  the  offer  although  it  is  most  generous." 

In  the  winter  of  1894  communities  and  states  surrounding  Chicago 
were  concerned  about  the  spreail  of  smallpox  from  Chicago.  Frequent 
visits  were  made  to  Chicago  by  health  officials  and  finally  a  meeting  was 
called  in  Chicago  of  state  and  city  health  officers.  Ouarantining  against  an 
infected  city,  town  or  state  was  then  in  vogue  though  not  so  popular  as 
formerlv  and  an  officer  who  would  "slap  on  a  (luarantine"  was  clispla\-ing 
great  erudition  and  efficiency. 

.\s  we  met  in  conference  it  was  plain  that  our  visitors  were  imbued 
with  the  thought  that  there  was  something  wrong  with  Chicago  in  its  trials. 
The  discussions  w-ere  inane.  There  were  no  suggestions  of  assistance  or 
help  of  any  kind.  One  illustration  will  suffice.  The  secretary  of  the  con- 
ference who  was  also  the  executive  officer  of  the  State  Board  of  Health  of 
Illinois,  when  asked  what  the  State  was  doing  said — 'A\'hen  any  community 
in  the  State  fails  to  stop  an  epidemic,  then  the  State  steps  in."  What  it  would 
step  into  or  any  word  of  what  should  be  done  was  not  mentioned. 

There  was  one  notable  exception.  Our  great  crusade  to  vaccinate  the 
entire  city  was  then  in  full  swing.  It  was  explained  to  the  visitors.  Finally 
Dr.  Ernest  W'ende,  Commissioner  of  Health  of  Huttalo,  New  York,  arose 
and  said:  "Gentlemen,  there  is  just  one  thing  that  will  stop  smallpox  and 
that  is  vaccination,  from  what  I  have  heard  today.  The  ^cope  and  system  of 
vaccination  in  Chicago  covering  the  entire  population  is  without  ])arallel  in 
the  history  of  previous  epidemics.  I  am  satisfied  the  disease  is  now  prac- 
tically under  control.  I  am  going  home  and  will  make  an  effort  to  do  the 
same  thing  in  Buffalo." 

Disiiifi'ctioii. 

Mattresses,  comforters  ami  other  things  of  small  value  that  could  not 
well   be  otherwise  disinfected   were  Inirned  anil   the  owners   paid    for   llu-ni. 


318  HEALTH  coN'nrrioNs  aftf.r  ISTT 

if  tlit'v  had  any  value.     C'i)ttnn  snoods  were  Ijoiled  and  the  rooms  suhjected 
to  >ul|iliur  funii,i;atii)n. 

Durini^r  the  eoin'se  nt  the  epidemic  the  flepartment  was  offered  the  use 
of  a  Ions;  tuhiiiar  steel  chaniljer  in  a  convenient  location  ihat  had  lieen  used 
for  (Iryinii  hiniher.  It  was  fitted  with  steam  pipes,  so  that  the  interior  could 
he  raised  to  a  high  temperature  and  was  therefore  suitahle  for  use  as  a  dis- 
infecting chamber.  It  had  a  conveyor  that  carried  its  load  from  the  entrance 
to  the  exit  at  the  other  end:  the  front  was  fitted  so  that  live  steam  could  be 
turned  in.  This  plant  was  accepted  and  tised  for  the  disinfecting;  of  bed- 
ding, clothing  and  similar  articles.  'I'he  goods  were  hauled  to  it,  put  in  the 
steam  chamber  and  were  taken  <iut  from  the  other  end  by  clean  hands,  put 
into  a  clean  conveyance  and  sent  back  to  the  owners. 

11  <tsj)itaht(i1  ion. 

Hospitals  in  JS'.lli  were  not  as  popular  as  they  are  now  and  smallpox 
hospitals  generallv  designated  as  "'jiest  houses"  were  to  be  avoided  at  all 
hazards.  Xo  himian  being  would  then  or  now  \dluntarily  go  to  a  pest 
house.  Xo  department  rules  or  statiU(ir\'  l.iw  could  overcome  the  horrur  of 
a  pest  house,  bear  of  the  pe.-^t  house  led  to  the  secretion  of  cases.  Sick 
children  were  wra])])ed  ti])  and  carried  tlu'ough  the  Mux  to  a  neighboring 
house  when  the  fann'lv  saw  the  health  department  conveyance  arrive  for 
their  removal.  <  'pen  \iolence  was  earl)'  ibreatened  and  occasionally  attempt- 
ed. An  ambulance  was  also  a  thing  to  l)e  avoided.  Jvenmval,  however,  was 
logical  and  necessary. 

Familiarity  with  these  facts  nattu-ally  led  to  the  consideration  of  other 
methods  than  force  to  bosjiitalizc  the  sick.  Xicely  upholstered  carriages 
drawn  by  a  pair  of  horses  were  ptirchased  and  put  to  tise  in  the  work,  'fhat 
helped  some. 

In  the  better  neighborhooils  the  argument  tb.it  non-removal  left  the 
family  in  more  danger  from  their  neighbors  than  from  the  authorities  was 
very  effective.  The  common  sense  of  the  difficult  situation  was  that  there 
was  some  influence,  some  |)erson  or  ])ersons  in  every  community  that  could 
overcome  the  fear  or  the  iirejudice  of  every  terrified  or  recalcitrant  individ- 
ual or  family  in  an\  proposition  that  was  right,  just  and  humane.  These 
influences  were  sought  and  found  .and  put  to  good  ])iirpose  in  the  removal 
of  the  sick  to  the  hospital  when  lin.alK  .ample  hospital  facilities  were  pro- 
vided. Difi'ereiit  connmmiiies  and  ditfereiit  nationalities  required  different 
management.  In  one  foreign  speaking  communitv  Sisters  of  Charity  were 
of  the  greatest  help.  They  acted  as  interpreters  and  pointed  out  the  advan- 
tage of  remo\;Ll  so  the  sick  could  have  s]iecial  care  and  the  premises  cleaned 
up.  'l'he\'  helped  seciu'e  v.accin.-ition  ;ind  in  every  way  were  efficient  helpers. 
.■\  .group  of  la\-  brothers  who  were  teachers  in  a  jiarochial  school  gave  the 


HEALTH    COXDITIOXS  AFTKR    18TT  319 

same  special  and  efficient  service,  livery  ease  of  smallpox  was  removed  to 
the  hospital  when  there  was  nuini  idr  them.  Mothers  of  small  children 
were  taken  along  to  the  hospital  when  they  would  go.  Telephones  were 
installed  so  the  sick  could  talk  to  the  folks  at  home. 

Tliis  e])idemic  occurred  nearlv  one  lumdred  years  after  the  immortal 
Jenner  had  discovered  vaccination  htit  there  was  a  woeful  lack  of  accurate 
knowledge  as  to  what  constituted  a  true  vaccination.  It  was  not  generally 
known  that  a  true  vaccination  left  a  typical  scar  unlike  that  from  any  other 
cause.  The  patient's  word  was  generally  accepted  as  to  whether  he  was  vac- 
cinated or  not.  Those  upon  whom  \accination  had  ever  been  attempted  con- 
sidered theuLselves  vaccinated.  Anvone  with  a  scar  on  the  arm  at  the  site 
of  vaccination  considered  themselves  vaccinated  and  the  bi.g.ger  the  scar  the 
more  certain  the\'  were. 

There  was  litle  knowtledge  e\xn  in  the  profession  of  what  constituted  a 
true  Jennerian  scar.  Jenner  it  is  true  had  painstakingly  described  it,  but  med- 
ical colleges  had  not  taught  it  and  jenner's  works  were  not  studied. 

Before  the  e])idemic  was  over  the  large  number  of  cases  reported  in  vac- 
cinated persons  and  the  freijuent  use  of  the  word  varioloid,  meaning  small- 
])ox  modified  by  vaccination  caused  incphry  to  be  made,  together  with  a 
careful  study  of  the  scar,  following  vaccination.  It  was  ultimately  found 
that  ]iersons  with  a  typical  jennerian  scar  did  not  contract  smallpox  at  all, 
not  even  varioloid,  b'rom  that  ilay  to  this  there  was  little,  if  anv  smallpox 
reported  in  the  truly  vaccinatetl.  It  was  found  too  that  the  large  scars  were 
made  by  some  extraneous  infection  and  that  in  such  cases  there  was  often  no 
true  vaccinal  result.  It  was  prior  to  the  day  of  glyeerinated  vaccine  Ivmph. 
The  vaccine  used  was  dried  on  lione  jioints  and  naturalh'  there  were  some 
sore  arms,  not,  as  we  then  pointed  out,  due  to  the  vaccine  but  as  a  result 
of  infection  either  on  the  point  or  introduced  afterward  bv  the  fingers  of 
the  patient. 

Large  groups  were  afraid  to  be  vaccinated,  others  objected  on  religious 
grounds  and  anyway  nol'.ody  wanted  to  be  meddled  with.  Then  there  were 
those  who  called  themselves  antivaccinationists,  who  made  a  sort  of  cult  of 
it  and  worked  themselves  up  into  a  line  frenzy  of  in  lignation  over  it.  How 
they  got  that  way  is  hard  to  understand.  They  were  the  most  unreasoning 
and  cantankerous  of  the  lot.  fbnvever  thev  generally  fafled  awav  when 
danger  of  small]>ox  was  imminent. 

One  \erv  eharming  lady  visited  the  commissioner  of  health  to  \dice 
the  objection  of  the  religious  organization  in  which  she  was  a  leader.  .She 
said  her  people  had  other  means  of  preventing  disease  and  that  they  did  not 
(|uail  before  smallpox.     She  also  said  she  and  her  church  w^ere  law  abiding 


320  IlICAl.Tll    IDNDITIONS   AFTER    18TT 

I'Ut  wanted  tn  talk  ii  (i\xt.  AnKini,'  others  (if  lu-r  art;'uniems  she  said  thai 
C'hrist  did  not  sav  anything  about  vaccination.  She  was  told,  with  sacri- 
ligious  ri>k,  that  vaccination  was  not  known  till  Dr.  Jenner  discovered  it 
less  than  one  hundred  years  a.^n  hut  that  nearly  all  the  followers  of  Christ 
were  in  favor  of  it  now.  Later  it  was  learned  that  her  organization  gave 
instructions  to  snlmiit  to  vaccination  when  the  authorities  demanded  it  but 
prayed  that  it  might  do  ihem  un  harm. 

The  department  was  frequently  m-ged  by  this  group  or  that  to  forcibly 
vaccinate  the  objectors.  The  fact  was  wi-  never  had  the  authority  to  vac- 
cinate b\'  force  nor  does  that  power  exist  now.  We  did  have  the  authority 
of  law  to  quarantine  any  who  refused  to  lie  vaccinated.  That  ])ower  was 
used  in  one  notable  instance  where  a  hotel  full  of  a  religious  grou])  were  shut 
in  for  weeks. 

A  total  of  3754  persons  had  smallpo.x  during  the  two  and  a  half  years 
of  its  reign.  Of  these  IvKi  dietl.  The  survivors  had  their  usefulness  im- 
paired in  many  instances.  Many  were  seriously  poc-marked  and  their  faces 
less  lovely  to  look  upon.  The  ex]jense  to  the  city  was  great.  I'he  imjiair- 
nient  to  traffic  and  commerce  was,  however,  rendered  almost  nil.  There 
was  the  toil  and  trial  of  thijse  in  the  department  who  cared  for  the  sick  and 
suppressed  the  disease.  Had  it  any  influence  on  the  jiresent  or  any  lesson 
for  the  future?  We  think  it  had  ami  that  not  only  Chicago  Init  the  world 
learned  a  useful  lessi.ui. 

The  Lesson. 

The  epidemic  was  due  to  the  neglect  of  vaccination.  It  demonstrated 
anew  that  none  who  were  truly  vaccinated  contracted  the  disease  and  that 
a  successful  vaccination  left  a  scar  typical  of  vaccination  and  unlike  any 
other  scar;  also  that  in  cases  of  skin  eruplinn.  where  a  diagnosis  was  difficult, 
the  presence  of  a  typical  Jennerian  scar,  made  the  decision  that  it  was  not 
sm.allpox  iiractically  certain.  It  showed  that  everybody  could  be  vaccinated 
when  it  was  properly  presented  and  hence  vaccination  by  force  was  poor 
])olic\-  and  unnecessary. 

Experience  showed  that  vaccination  with  jnire  vaccine  did  not  cause  a 
bad  sore  and  left  only  a  small  scar  and  that  large  scars  were  due  to  extrane- 
ous infection  and  as  a  rule  did  not  |)rotect. 

Cholera 

During  the  .")()  years  since  the  establishment  of  the  .State  I'oard  of 
Health,  a  jjeriod  which  may  be  designated  as  one  of  suppression  and  control 
of  disease,  there  is  no  better  illustration  of  a  comprehensive  campaign  car- 
ried on  for  the  prevention  of  an  epidemic  by  a  state  health  department  than 
the  safeguards  and  sanitary  [jrecautions  taken  by  the  Illinois  State  Board  in 


HEALTH  CONDITION'S  AFTER  18T7  321 

1884  and  1885,  in  its  efforts  to  prevent  the  invasion  of  Asiatic  cholera.  Tliis 
disease  had  frequently  invaded  Illinois  prior  to  18;^.  the  year  in  which  the 
State  Board  was  estahlished. 

The  ('Jidlcra  Duiiijir  in   1SS4. 

.\s  early  as  July.  1883,  the  danger  of  an  invasion  of  Asiatic  cholera  into 
the  United  States  and  Illinois  was  noted  hy  the  State  Board,  and  preliminary 
action  was  taken  with  reference  to  measures  necessary  to  resist  its  introduc- 
tion and  til  prevent  its  sjjread. 

The  safeguards  determined  U])on  as  the  most  promising  for  success 
were  two- fold.  The  first  was  an  intra-state  measure  and  was  to  take  the 
form  of  a  state-wide  sanitary  survey  to  determine  the  sanitar\'  needs,  and  a 
sanitary  "clean-up"  if  data  ohtained  through  the  surve\'  indicated  that  this 
was  needed.  'Ihe  second  was  inter-state  and  related  to  aiding  and  insist- 
ence upon  enforcement  of  quarantine  requirements  and  insjiection  methods 
along  the  Gulf  and  Atlantic  coast,  together  with  efforts  to  secure  inqjroved 
sanitation  and  cleanliness  of  the  various  neighboring  states. 

'ihe  cleanliness  campaign  was  based  on  the  prevailing  theorv  in  regard 
to  origin  and  spread  of  cholera,  and  was  possibly  also  conducted  with  a 
view  that  it  would  have  a  good  effect  in  the  saving  of  lives  from  other  tilth 
diseases  far  in  excess  of  the  mortality  from  the  cholera  itself,  unless  it  shonld 
spread  beyond  all  expectation. 

The  Board  inaugurated  this  campaign  witli  the  following  statement  to 
the  public:  "An  epidemic  spread  of  Asiatic  cholera  now  seems  inniiinent. 
Mention  is  m;ide  of  cases  in  hjigland  and  I'rancc  Whether  the  disease  will 
cross  the  .\tlantic  fr(]m  the  luist  will  depend  iqion  the  efficac\-  of  measiu'es 
emjiloyed  to  confine  contagion  to  the  ]iresent  localities." 

To  guard  against  the  invasion,  the  secretary  of  the  State  B(  ard  made 
the  following  statement  and  recommendation: 

"My  experience  and  observation  lead  to  tlie  conclusion  that  it  is  not  judicious 
to  place  entire  reliance  on  quarantine  measures,  no  matter  how  administered, 
should  the  disease  become  epidemic  in  countries  or  points  with  which  this  country 
has  close  commercial  relations.  As  Asiatic  cholera,  although  it  may  invade  places 
in  good  sanitary  condition,  tinds  its  most  congenial  habitat  where  filth  in  any 
form  abounds,  the  best  attainable  sanitary  condition;  clean  streets  and  premises, 
the  prompt  and  proper  disposal  of  organic  refuse,  night-soil,  and  all  forms  of 
sewage;  well  ventilated  habitations,  with  dry.  clean  basements;  a  pure  and 
sufflcient  water  supply;  and  good,  individual  hygiene,  including  personal  cleanli- 
ness, proper  diet,  and  regular  habits  of  life — these  are  the  best  safeguards  against 
Asiatic  cholera. 

"I  have  to  respectively  recommend  that  a  thorough  and  svstematic  sanitary 
survey  of  the  State  be  inaugurated  by  the  first  of  January.  1SS5." 

The  results  of  the  efforts  made  in  1  .siS4  to  secure  a  general  inspection 
and  improvement  of  sanitary  eonrlitioiis  were  as  follows: 

Reports  Irom  •.':>()  cities,  towns,  and  villages  were  received  in  re|iiv  to 
the   circular  seiu   out,   and   an   innnense   amouni    of    work    was   acconi])lished 


32"3  iiEALTii  coxnrTioxs  akteu  1877 

in  remedying  the  detects  disclosed  by  the  inspections.  The  secretary  per- 
sonallv  inspected  a  number  of  the  State  institutions,  and  found  them  in  as 
good  sanitary  condition  as  could  be  expected  in  view  of  faulty  construction, 
or  location,  from  a  hygienic  standijoint.  Suggestions  for  imi)rovement  were 
given  and  carried  out  as  far  as  practicable. 

s.\.\iT.\RY  survey:  At  the  next  meeting  of  the  Board,  the  secretary  by 
rcsdkniiin  \\a^  auilmrized  "'I'd  prepare  the  necessary  l)lank>  and  in>tnu'tii  in>. 
and  til  distriljute  the  same  to  the  proper  authorities  of  cuunties.  tii\\ii>hips. 
and  municipalities,  tdr  a  thorough  and  systematic  sanitary  survey  of  the 
State,  to  be  begun  by  January  1.  1885,  or  as  soon  thereafter  as  iiracticable." 

The  secretary  explained  that  it  was  proposed  to  l)egin  work  in  the 
southern  portion  of  the  State,  and  to  work  northward  as  rapidly  as  the 
weather  would  permit,  so  that  by  May  1  the  sanitary  condition  of  every 
dwelling  in  all  of  its  parts,  of  all  premises,  outhotises.  wells,  cisterns,  and 
other  belongings  should  be  made  known,  the  remedy  of  defects  be  pushed, 
and  the  authority  of  the  State  Board  be  exerted  wherever  necessary  in  su])- 
plemcni  the  efforts  of  the  local  authorities  of  the  State  to  reust  the  threat- 
ened invasion  of  Asiatic  cholera. 

A  much  greater  share  than  u^ual  of  the  labor  of  the  Pmard  in  ISS.")  was 
devoted  to  purely  sanitary  work  and  efforts  to  prevent  the  invasion  and 
spread  of  cholera.  The  records  show  that  a  total  of  300,000  houses  and 
premises  were  inspected  in  395  cities,  towns,  and  villages.  These  inspec- 
tions were  made  from  March  to  December,  1885,  and  embraced  '.Hi  of  the 
102  counties. 

The  thoroughness  of  these  inspections  made  at  that  early  ]X'riiid  wnuld 
do  credit  to  any  state-wide  sanitary  survey,  and  the  relati\-elv  Inw  cost  of 
this  survey  is  remarkable  for  even  that  period. 

These  inspections  embraced  every  material  condition  affecting  health, 
individual  and  public ;  site  of  house  ;  its  age,  material,  ventilation,  condition, 
especiallv  of  Ijasement  or  cellar,  of  cesspools,  sinks,  drains,  outhouses  and 
water  supply;  of  the  yard  and  stables,  barns,  etc.:  tlie  vaccinal  status  of 
occu])ants ;  the  occurrence  of  certain  diseases,  etc.  They  disclosed  in  382 
places  from  which  reports  were  received  at  the  end  of  the  \ear.  a  total  of 
474,831  defective  conditions  and  nuisances  prejudicial  to  health,  of  which 
number  441,593,  or  over  90  per  cent,  were  reported  abated  or  remedied. 

The  sanitary  surveys  of  cities  and  towns  were  begun  early  in  June,  and 
the  house-to-house  inspection  was  resumed  in  the  extreme  southern  ]Kirtion 
of  the  State  as  soon  as  the  weather  permitted,  and  was  In-  midsummer,  suc- 
cess full  v  prosecuted  throughout  its  entire  area. 

These  surveys  were  at  first  largely  tentative  and  experimental;  but 
they  were  the  means  of  discovering,  in  many  cases,  a  multitude  of  defects 


HEALTH   CONDITION'S  AFTER    ISTT  '323 

and  evils,  the  dangerous  importance  (if  which  had  heen  overlooked  or  whose 
existence  had  not  been  suspected.  They  gave  a  distinct  impetus  to  the  Ikiusc- 
to-house  inspections.  They  aroused  communities  to  the  importance  of  their 
sanitary  conditions.  The  series  of  circulars  prepared  by  the  secretary,  and 
the  Schedule  of  Questions — revised  fium  that  originally  prepared  by  a  com- 
mittee of  '28  prominent  sanitarians  under  the  direction  of  the  American 
Public  Health  Associatii)n  were,  in  not  a  few  instances,  the  first  sanitary 
instructidn  to  receive  a  practical  application. 

The  surveys  included  all  data  necessary  to  a  complete  descri])tion  of 
the  city  or  town  as  to  its  location,  population  and  climate;  topography,  water 
supply;  drainage  and  sewerage;  streets,  alleys  and  public  grounds;  habita- 
tions; gas  and  lighting;  disposal  of  garbage  and  excreta;  markets  and  food 
supply ;  slaughter  houses  and  abattoirs ;  manufacturies  and  trades  ;  hospitals 
and  public  charities ;  police  and  prisons ;  fire  establishments ;  cemeteries  and 
burials;  public  health  laws  and  regulations;  municipal  officials;  registration 
and  statistics  (.)f  deaths  and  diseases;  municipal  sanitary  expenses;  and 
public  schools;  the  whole  embracing  nearly  000  separate  questions  grouped 
under  19  general  heads. 

The  total  cost  of  these  insjiections  was  estimated  at  about  $."iii,(l()()  for 
everything  except  the  work  actually  done  or  caused  to  be  done  bv  the  house- 
holder, tenant,  or  owner.  In  Chicago  it  was  a  little  less  than  1  T  cents  for 
each  inspection,  including  pay  of  inspectors,  wages  of  laborers,  hire  of  teams, 
cost  of  disitifectants,  printing,  stationery,  etc. 

Dr.  Oscar  De  Wolf,  health  commissioner  of  Chicago,  reported  that 
the  death  rate  from  the  filth  diseases  in  Chicago  was  reduced  1')  jier  cent, 
and  stated  that  there  can  be  no  (|uestion  that  much  of  this  decrease  in  the 
preventable  mortality  was  due  to  the  house-to-house  inspection  and  kindred 
efforts  which  were  made  jiossible  ihrmigh  the  sjiecial  a])pro]iriaiion  in  the 
anticipation  of  cholera. 

Il  is  believed  to  be  entirely  within  the  bounds  to  sav  that  at  the  close 
of  ISS.")  the  State  was  in  a  cleaner  and.  consequently,  healthier  condition 
than  any  ei|ual  poinilation  liad  ever  been  before  at  the  same  iieriod  of  occu- 
pancy of  the  Soil. 

During  188G  the  Board  was  still  in  feai"  of  invasion  of  .\siatic  cholera. 
The  work  of  the  sanitary  survey  was  continued.  The  house-to-house  in- 
spections were  completed  where  nol  fnii'-Iicd  the  year  before,  and  exlciided 
to  new  territory,  so  that  they  embraced  an  ;iggregale  of  nearly  half  a  million 
inspections  and  reinspections  of  houses  and  premises,  in  .ibout  hiu  cities, 
towns,  and  villages. 

While  the  lioard  had  been  thus  successful  in  organizing  and  promoting 
sanitary  work  by  nuuiicipalities  and  individuals,  it  continued  the  effort   to 


324  lll'.Al.TII    CONDniONS    AKTI'-.K    1ST* 

supplenifiit  ^^cll  local  aciidii  by  ])r()>cciilin.L;  the  investigatiim  iiitci  tin-  writer 
su])plies  of  the  State,  the  (lis])iisal  of  se\\ai,'e.  and  ])olluti(in  (if  streams. 
These  were  matters  alTecliiig  large  areas  uf  trrritury  in  eommcin,  and  yet. 
ill  the  nature  of  the  case,  they  were  such  as  cnnlil  nut  he  cnntrnlled  hy  the 
independent  action  of  the  communities. 

At  the  close  of  the  year,  an  at;i;ret;ate  of  41)11, S:i';!  ins])ections  and  ri'in- 
spections  had  been  made,  emhracini;  e\ery  importrml  item  pertaininij;  to  the 
sanitary  status  of  li.'l."!..")  n  premises  in  :!1IS  cities,  towns  and  vill.ayes.  with  .an 
aggregate  population  of  1. <!;■;. ;:>!  inh.ahitants.  In  all  hut  three  of  these 
places  \\(irk  was  lieytm  prior  to  issi;,  hut  at  the  close  of  the  previous  year, 
the  aggregate  niimlier  of  inspections — exclusive  of  Chicago — was  onh' 
224,2()0,  so  that  the  increase  (hiiing  l.s.Sd  was  considerably  o\er  HIO  per 
cent.  A  large  number  (  1(1 1. '.'S-"))  of  these,  however,  were  rt-inspections.  the 
actual  number  of  additional  jiremises  inspected,  amounted  to    ll.'i.Kl-i. 

QUAK.\.\Tj\i-:  .Mi-:.vsuRi''s  I'LAXM-.ii:  While  this  extensixc  sanitary  sur- 
vey and  clean-tij)  was  going  on  within  practicalK-  e\ery  comity  of  the  ."^tate. 
the  Board  was  also  energetic  in  trying  to  keep  cholera  from  entering  th:_' 
United  States  and  especially  Illinois. 

Provision  was  made  for  guarding  against  any  introduction  of  the  dis- 
ease, by  defining  a  system  of  border  quarantine  inspection,  b'or  this  purpose 
the  Thirty-fom-th  Cicneral  Assemlily  made  a  contingent  a])propriation  of 
$40, OIK)  to  be  used,  upon  the  recommendatii  n  of  the  Board,  in  case  of  tlie 
outbreak  or  threatened  outbreak  of  any  epidemic  or  malignant  disease,  such 
as  Asiatic  cholera,  smallpox,  yellow  fever,  or  to  defray  the  expense  of  pre- 
venting the  introduction  of  such  diseases,  or  their  spread  froi.i  ]ilace  to  place 
within  the  State,  and  suppressing  outbreaks  which  might  occur,  and  in  inves- 
tigating their  causes. 

In  the  event  of  such  outbreak  or  thieatened  outbreak,  it  w.is  planned  to 
establish  quarantine  inspection  stations  at  '.'I  designated  points  of  enlranc-" 
of  important  railroad  lines  along  the  eastern  and  southern  boimdaries  of  th;' 
State,  and  at  points  upon  the  Ohio  and  Mississippi  Rivers — or  at  so  many 
of  these  as  mi'^ht  be  necessary — for  ins])ecting.  (piarantining.  di.infecling 
and  cariuL;   lor  cases  ol   e|)idemic  disease. 

.\l  the  meeting  of  the  .Sanitary  Council  of  tlie  .Mississippi  \  .alley,  similar 
action  was  urged  u|ion  the  health  ntficials  of  neighboring  states.  Satisfac- 
tory action  was  t.alsen  b\'  the  CHuncil  upon  this  recommendation,  and  thus 
another  step  was  taken  in  perfecting  the  protection  of  the  State  agaiu'-t  an 
epidemic  of  imported  cont.a^iotts  or  infectious  disease. 

Cliolcra  liiradcs  ['nit,  ,1  States  in   7W7. 

In  the  fall  of  Iss;.  Asiatic  cho'era  was  introtluced  into  the  I'nited 
States,   a   disaster   which    had    been    feared   by    the    State    Hoard    since    1  S,S;_J. 


HEALTH    CONDITION'S  AFTER    1877  '325 

These  cholera  cases  arrived  late  in  the  year  (  end  uf  September)  and  a  tulal 
of  34  cases  had  been  recorded  in  New  "S'ork  and  vicinity  by  October  I  1,  iss;. 
It  is  uncertain  hnw  nuich  credit  shdulil  lie  ijiven  the  Board  and  its  activ- 
ities in  preventing  Asiatic  cholera  in  the  State,  bnt  it  is  nevertheless  a  fact 
llrit  the  Itical  epidemic  in  the  Xew  ^'()rl^  (|uarantine  zone  did  not  reach  Illi- 
nois. 'I  he  I'.oard  toijk  no  chances,  but  made  a  determined  effort  to  protect 
the  health  and  lives  of  the  people  by  maintaining  a  state-line  quarantine  by 
insjiections  of  passengers  on  railways  coming  from  infected  cities. 

CJiulrra  Iiiradcs  UiiltctI  Stales  in   IS!):?. 

In  IS!)-.'  a  conference  of  Western  State  Floards  of  Health  was  called, 
which  met  and  drafted  seven  agreed  rules  for  inter-  and  intra-state  pro- 
cedure to  be   followed  in  the  then  existing  emergencv  in  regard  to  elmlera. 

Dr.  F.  W.  Reilly  was  elected  to  act  as  secretarv  of  the  conference.  He 
was  authorized  to  act  for  the  Hoard  in  the  case  of  a  threatened  jiandemic  of 
Asiatic  cholera,  in  the  interim  pendmg  the  next  meeting  and  to  call  an 
emergency  meeting  of  the  members  at  his  discretion. 

After  the  adjournment  the  secretary  engaged  in  a  telegraphic  corre- 
spondence with  the  Xew  ^'ork  City  Hoard  of  Health  and  with  Dr.  John  H. 
Ranch,  who  was  at  the  time  in  that  city.  As  a  result  of  the  information 
thus  obtained,  and  after  consultation  with  Dr.  C/riftith,  the  secretarv  fur- 
nished the  following  statement  for  publication: 

"Chicago.  September  14,  1S92. 

"While  the  intelligence  of  five  deaths  from  Asiatic  cholera  among  residents 
— not  immigrants — of  New  York  City,  one  of  these  eight  days  ago,  was  a  most 
unpleasant  surprise  to  Western  health  officials,  still  there  is  nothing  in  the  situa- 
tion to  cause  panic  or  even  excitement.  The  delay  in  admitting  the  existence 
of  the  disease  was  natural,  but  it  does  not  appear  that  any  precaution  has  been 
neglected  on  this  account.  From  tlie  first  suspicion  the  cases  have  been  treated 
as  it  it  was  known  that  tliey  were  genuine  Asiatic  cholera.  Premises  have  been 
disinfected,  inmates  kept  under  strict  surveillance  and  the  most  rigid  care  has 
been  exercised. 

"In  its  own  interest  New  York  cannot  afford  to  have  any  spread  from  these 
cases,  nor  from  others  which  may  be  now  reasonably  anticipated  before  the  advent 
of  cold  weather. 

"As  to  any  immediate  danger  to  the  country  from  these  sporadic  cases,  there 
are  these  facts  to  be  considered: 

"1.  The  cases  have  occurred  among  a  class  of  persons  not  likely  to  start 
an  exodus  from  the  localities  and  so  to  spread  the  infection. 

"2.  As  already  recited,  reliance  may  he  placed  on  the  natural  interest  of 
New  York  to  make  every  effort  to  prevent  any  spread. 

"3.  Every  day  brings  us  nearer  the  season  when  cholera,  at  least  in  this 
country,  is  cliecked  by  a  low  temperature. 

"4.  The  history  of  the  disease  on  this  continent  shows  that,  while  it  has 
repeatedly  effected  a  foothold  on  the  mainland  in  the  fall  of  the  year,  it  has 
never  been  until  repeated  introductions  that  it  has  spread  as  an  epidemic.  In 
the  epidemic  of  1854  it  took  eighteen  months  after  the  first  cases  on  the  mainland 
to  effect  a  lodgement  and  become  epidemic. 

"5.  The  sanitary  defenses  of  the  country  were  never  so  well  organized  to 
battle  with  and  suppress  an  epidemic  of  any  preventable  disease. 


32G  llEAl.TIl    COXDITIOXS   AKTKU    1S7T 

"Tlic  practiciil  (IctUution  from  these  considerations  is  that,  as  already  said. 
there  is  no  occasion  for  panic  or  even  excitement. 

"What  remains,  as  the  lesson  of  the  situation,  is  that  every  community  and 
commonwealth  should  realize  in  practical  effort,  that  its  immunity  from  cholera, 
as  from  other  preventable  disease,  rests  with  itself.  It  must  work  out  its  own 
salvation  and  not  rely  upon  any  vicarious  protection  of  quarantine.  Every  source 
of  filth,  of  pollution  of  water,  soil  or  air,  must  receive  prompt  and  effective  atten- 
tion, and  not  only  must  municipalities  exert  themselves,  but  every  householder 
for  himself  must  put  his  own  house  and  premises  in  order. 

"No  cleanly  city,  town  or  villa.s;e — with  a  proper  disposal  of  excreta  and  with 
a  pure  water  supply — need  apprehend  a  visitation  of  cholera.  In  all  human  prob- 
abilities there  remains  from  now  until  next  spring  in  which  to  perfect  the  work 
of  sanitation  already  well  under  way  throughout  the  length  and  breadth  of  Illi- 
nois. With  the  present  warning,  the  municipality  which  fails  to  utilize  these 
intervening  months  will  be  culpably  criminally  derelict  in  an  obvious  and  im- 
perative duty. 

"The  Illinois  State  Board  repeats:  There  is  no  occasion  for  panic — there 
is  every  occasion  for  a  general  cleaning  up." 

Ill  view  of  this  situation,  it  was  decided  to  keep  a  strict  check  mi  all 
iiiiiiiigrants  enlering^  the  State.  In  pursuance  to  this  plan,  all  immigrant-car- 
rying transportaliciii  cnnipanics  were  iintiticd  in  September,  189'2,  not  to  bring 
into  the  State  of  lllinnis  any  inimigrant,  imr  the  ])ersoiial  effects  and  be- 
longings of  am-  immigrant,  without  first  receiving  satisfactory  assurance 
that  such  immigrant  and  his  or  her  personal  etfects  and  belongings  are  free 
from  the  danger  of  introducing  the  contagion  of  an  epidemic,  contagious  or 
infectious  disease. 

The  companies  were  further  instructed  to  accejjt  only,  as  satisfactory 
assurance,  the  certificate  of  an  inspector  of  the  L'nited  States  Marine  Hos- 
pital Service,  setting  forth  that  the  individual  immigrant  has  been  under 
observation  long  enough  to  determine  that  he  or  she  has  not  the  germs  of 
cholera  in  the  svstem,  and  that  he  or  she  is  vaccinally  protected  against 
sniallpcjx  :  that  all  the  ])ersonal  effects  and  belongings  of  said  immigrant  have 
been  sttbjected  to  ])roper  disinfection;  and,  furthermore,  that,  in  the  pro- 
fessional jtid^menl  of  the  inspector,  the  individual  immigrant  referred  to 
and  his  or  her  belongings  are  free  from  any  danger  of  conveying  contagion 
or  infection  to  others. 

At  the  December.  1S!)"2.  meeting,  the  l:>oard  ])assed  a  resolution  reipiest- 
ing  the  legislature  to  provide  a  contingent  fund  to  be  used  in  case  of  the  in- 
vasion or  threatened  invasion  of  cholera. 

.\t  the  lanuarv.  18i)3.  meeting  of  the  lioard.  much  concern  was  ex- 
pressed bv  the  secrctarv,  Dr.  F.  W.  Keilly.  concerning  Chicago's  financial 
inability  to  coiuinue  to  inspect  all  trains  carrying  inniiigrants,  in  order  to 
])rotect  Chicago  and  Illinois  against  invasion  of  cholera  and  smallpox.  On 
March  '^3,  18!);5,  he  wrote  a  letter  to  Governor  Altgeld,  informing  him  of 
this  condition,  and  in  reply  received  instructions  to  contintte  the  immigration 
inspection  as  ;i  ])reventive  measure  against  cholera,  etc.,  the  expense  to  be 
defrayed  out  of  the  contingent  fund  appropriated  for  kindred  purposes. 


HEALTH   CONDITIOXS  AFTER   1877  327 

The  health  commissioner  of  Chicago  was  duly  advised  of  the  Gov- 
eriKirV  apijrnval.  and  was  authorized  to  select  and  appoint  eight  inspectors, 
who  should  receive  pay  at  the  per  diem  rate  of  two  dollars  and  a  half  ( $-2.r)0) 
for  each  day  of  actual  service,  the  expense  to  be  defrayed  out  (if  the  con- 
tingent fund  of  the  State  Board  of  Health.  This  service  was  cnntinued 
until  the  end  of  the  following  June. 

Thus  ends  the  history  of  cholera  in  Illinois.  In  fact  it  was  not  a  history 
of  cholera  at  all,  since  the  State  Board  was  established  in  1877,  but  a  chron- 
icle of  measures  instituted  to  prevent  the  invasion  of  the  State  by  this  disease. 
No  cases  of  the  disease  occurred  in  the  State  during  this  period.  Twice 
chnlcra  invaded  the  United  States,  once  in  1887,  and  again  in  1892. 

The  elaborate  precautions  which  were  started  by  the  State  Board  of 
Health  in  1S83,  under  Dr.  Rauch's  direction,  apparently  helped  to  prevent 
the  spread  of  cholera  into  the  State  in  1887,  when  immigrant  inspection  and 
the  machinery  for  tlie  control  of  epidemics,  was  not  perfect  or  so  well 
organized  on  a  national  basis  as  in  later  years.  This  was  a  time  when  every 
state- and  community  had  to  be  on  guard  for  such  natiimal  invasions  of 
pestilence. 

The  18!)3  invasion  of  cholera  and  its  prompt  restriction  and  check  at 
the  vicinity  of  the  port  of  entry,  is  evidence  of  the  effectiveness  of  modern 
methods  of  disease  control,  based  on  accurate  knowledge  of  the  causes  and 
mode  of  transmission  of  infectious  diseases  and  augurs  well  of  what  would 
occur  should  the  State  again  be  threatened  with  the  invasion  of  any  such 
pestilential  disease,  now  or  in  the  future. 

Yellow  Fever 

The  panicky  situation  concerning  yellow  fever  in  the  South  in  1878  was 
the  first  big  public  health  problem  to  divert  temporarily  the  attention  of 
the  State  Board  of  Health  from  its  activities  in  the  enforcement  of  the  Med- 
ical Practice  .Act. 

.\  description  of  the  yellow  fever  epidemic  of  1878  at  Cairo,  the  puint 
of  greatest  incidence  in  Illinois,  can  best  be  visualized  by  quoting  from  Jdhn 
M.  Lansden.  a  resident  of  Cairo  at  the  time  and  an  eyewitness  of  the  out- 
break. In  his  history  of  Cairo,  Illinois,  he  writes  in  part  as  follows  con- 
cerning the  epidemic : 

"The  ten  days  begiuning  with  July  9.  1S7S.  were  probably  the  hottest  ten 
successive  clays  in  the  history  of  the  City.  During  that  time  the  writer  was  kept 
at  home  by  an  attack  of  illness  and  was  treated  by  Dr.  W.  R.  Smith,  whom  most 
of  us  remember  as  one  of  our  most  prominent  citizens  and  physicians.  On  enter- 
ing the  room  one  of  those  days  and  while  wiping  the  perspiration  from  his  face, 
he  said.  'John,  we  are  likely  to  have  yellow  fever  in  the  south  within  a  month  or 
two.'  The  doctor's  prophecy  came  true.  The  first  case  occurred  in  the  south  about 
the  first  of  August.  It  moved  on  nortliward  and  soon  appeared  at  Nachez,  Vicks- 
burg,   -Memphis,   and   Hickman,   and   reached   Cairo   September   12.     It   is   said   by 


328  HEALTH    CONDITIONS   AFTICK    1ST? 

miiiiy  persons  that  Mr.  OlKTly.  the  father  of  the  Hon.  John  H.  ()l)erly,  died  of  the 
fever  a  few  days  before  the  12th.  On  the  12ih  there  were  two  deaths;  one  of  them, 
Mr.  Thomas  Nally.  editor  of  the  Bulletin,  and  the  other,  Mr.  Isaac  Mulkey,  a  son 
of  Judge  John  H.  Mulkey,  and  also  of  the  Bulletin  office.  Those  deaths  caused  a 
panic  in  the  city,  and  the  afternoon  and  evening  of  that  dav  witnessed  the  de- 
parture of  hundreds  of  people  from  the  city. 

"For  some  three  or  tour  weeks  prior  to  that  time  there  had  existed  in  the 
city  an  unseemly  controversy  as  to  whether  the  fever  would  probably  reach  Cairo 
or  not.  Were  one  to  turn  to  the  files  of  the  Bulletin  and  the  Cairo  Evening  Sun 
for  the  last  half  of  August  and  the  first  twelve  days  of  September  of  that  year, 
he  would  see  what  a  state  of  feeling  existed  in  the  city;  the  one  party  insisting 
that  there  was  little  or  no  danger  and  the  other  that  there  was  very  great  danger 
and  that  every  possible  efl'ort  should  be  put  forth  to  keep  the  dreaded  disease  out 
of  the  city.  The  Bulletin  led  off  as  was  its  custom  and  criticised  with  unnecessary 
severity  every  one  who  chose  to  differ  with  it.  It  was  strongly  supported  by  a  few 
of  our  prominent  citizens  who  felt  that  it  was  their  duty  to  maintain  our  supposed 
immunity. 

"I  can  best  describe  that  peculiar  state  of  things  preceding  September  12th  by 
saying  that  it  was  not  quite  as  bad  as  the  yellow  fever  itself.  I  had  been  attending 
court  at  Jonesboro  and  was  told  by  the  conductor,  on  offering  to  go  aboard  the 
train  at  Jonesboro  to  come  home,  that  he  could  not  take 'me  on  account  of  the 
quarantine  at  Cairo.  I  prevailed  upon  him  and  came,  and  on  reaching  the  northern 
part  of  the  city  I  saw  the  levees  patrolled  by  armed  guards.  One  or  two  of  them 
went  through  the  train  to  ascertain  who  might  and  who  might  not  be  permitted  to 
go  on  into  the  city. 

"When  1  reached  the  city,  1  was  surprised  beyond  measure  to  see  the  state 
of  things  prevailing.  On  every  hand  were  seen  all  kinds  of  vehicles  carrying 
trunks  and  every  other  description  of  baggage  to  the  railroad  stations.  They 
were  driven,  some  of  them,  almost  at  furious  rates  of  speed.  In  a  word — there 
was  a  panic,  which  I  need  not  attempt  further  to  describe. 

"I  left  on  the  same  Illinois  Central  train  about  eight  o'clock  that  evening, 
on  which  were  Mr.  Oberly  and  hundreds  of  other  citizens  of  the  town.  I  remained 
away  until  the  2d  of  October,  when  I  returned  home,  having  seen  in  the  Cairo 
Evening  Sun,  of  September  24th,  the  following  notice: 

"The  Cairo  public  schools  will  open  on  Monday,  September  30th  under  the 
superintendency  of  Prof.  G.  G.  Alvord.' 

"The  schools  opened  at  the  time  announced,  but  were  discontinued  October 
4th.  On  Sunday  and  Monday,  October  6th  and  7th.  there  were  six  deaths,  among 
them  Miss  Marie  Powers,  one  of  the  public  school  teachers.  These  deaths  occa- 
sioned another  exodus,  not  quite  so  panicky  nor  quite  so  large;  and  it  was  not 
until  the  latter  part  of  October  that  the  people  began  returning  home,  and  it  was 
not  until  far  into  November  that  all  had  gotten  back. 

"The  Bulletin  had  suspended  publication  with  its  issue  of  September  12tli, 
and  did  not  resume  publication  until  the  first  day  of  November.  Mr.  D.  L.  Davis, 
the  editor  of  the  Cairo  Evening  Sun,  and  his  family  had  also  gone  from  the  city, 
and  had  left  Mr.  Walker  F.  McKee  in  charge  of  the  paper.  Walter,  for  most  of  us 
were  accustomed  to  address  him  by  that  name,  remained  at  his  post  and  gave 
the  city  a  very  faithful  account  of  what  was  daily  taking  place.  As  bad  as  the 
news  often  was  which  it  contained,  the  residents  were  eager  for  its  appearance 
in  the  evening,  and  most  of  them  forwarded  copies  to  their  friends  who  had  gone 
from  town  and  who  were  anxious  to  know  the  state  of  things  at  home.  Mr.  Davis 
removed  from  Cairo  to  Chicago  a  few  years  afterwards,  and  kindly  handed  to 
me  all  the  numbers  of  the  'Sun'  which  covered  the  yellow  fever  period. 

"The  facts  are  just  as  above  given.  There  were  about  one  hundred  cases 
and  about  fifty  deaths. 

"I  have  devoted  these  few  pages  to  the  epidemic  of  the  fever  because  it  was 
an  era  in  the  city's  history.  One-third  of  the  people  left  the  city.  Many  remained 
who  could  and  should  have  gone.  Their  reasons  for  remaining  were  various;  and 
sometimes  they  could  give  none  at   all.     It  was  a  simple  disinclination  to  leave 


HEALTH    COXniTIOXS   AFTKU    ISTT  3'i9 

lionie.  There  was  a  cuntmuing  hope  that  the  danger  would  soon  pass,  but  it  per- 
sisted instead.  To  some  it  was  a  question  of  means;  for  to  go  and  remain  away 
even  for  a  short  time  required  money  for  the  trip  and  board.  Many  had  no  friends 
or  relatives  to  whom  they  could  go.  Pew  persons  from  the  surrounding  country 
desired  to  see  any  from  Cairo.  Many  whole  families  would  not  go  because  they 
could  not  decide  who  should  remain,  and  they  feared  leaving  their  homes  unpro- 
tected. 

"Business  was  suspended;  only  just  enough  done  as  seemed  actually  necessary 
for  the  people  at  home.  The  days  were  unusually  bright,  in  sharp  contrast  with 
the  doubly  dark  and  silent  nights.  Part  of  the  time  persons  could  not  be  abroad 
at  night  without  passes  of  some  kind  from  the  authorities.  In  a  word,  everything 
spoke  plainly  of  the  reign  of  pestilential  disease. 

"The  city  government  of  course  went  on.  It  had  to.  Mayor  Winter  was 
equal  to  the  occasion,  and  to  be  equal  to  such  an  occasion  seems  capability  for  al- 
most anything,  but  he  seemed  made  for  it  as  for  some  special  occasion.  Jack,  like 
so  many  public  men  of  the  country,  liked  to  do  things  in  a  kind  of  showy  way, 
not  exactly  spectacularly,  but  that  word  expresses  something  of  the  idea.  Jack  had 
been  so  harrowed  by  the  Bulletin  and  others  about  the  fever,  that  he  seemed  some- 
how to  be  glad  that  they  and  not  he  had  proven  false  prophets;  and  when  the 
fever  came  he  met  it  with  an  undaunted  face.  He  could  not  rescue  its  victims;  but 
he  and  the  few  trusty  men  he  had,  buried  them  in  the  shortest  possible  time  and 
yet  with  all  the  care  and  ceremony  of  which  the  deadly  situation  would  admit. 
But  it  must  not  go  on  further  or  attempt  to  describe  the  pestilence  that  walked 
in  darkness  or  the  destruction  that  wasted   at  noonday. 

".lack  Winter  was  no  better  than  many  of  the  rest  of  us;  but  if  at  the 
end  of  all  things  there  is  a  balancing  of  accounts  for  every  man.  Jack's  account 
will  have  opposite  September  and  October,  1878,  a  very  large  credit.  Of  the  rather 
few  persons  on  whom  he  relied  for  attention  to  families  in  need  and  for  other 
aid  to  the  city  authorities,  I  may  mention  Mr.  William  H.  Schutter.  I  do  so  be- 
cause of  my  personal  knowledge  of  much  of  his  work.  Of  the  many  persons  who 
remained  out  of  a  sense  of  duty  to  those  who  could  not  go  or  did  not  choose  to 
go,  I  may  mention  the  Rev.  Benjamin  V.  George,  of  the  Prebyterian  Church  and 
Father  Zabel  of  St.  Joseph's  Catholic  Church,  of  whose  constant  care  and  devotion 
to  the  stricken  families  of  the  town  it  would  be  impossible  to  say  too  much.  Doc- 
tor Roswell  Waldo,  of  the  Marine  Hospital,  gave  up  his  life  in  the  work  he  did, 
which  extended  alike  to  all  persons  needing  his  service.  He  died  at  St.  Mary's  In- 
firmary October  18th,  after  a  long  illness  which  kept  the  community  alternating 
between  hope  and  fear  for  his  life.  The  Sisters  of  St.  Mary's  Infirmary  did  every- 
thing in  their  power,  as  they  always  do.  It  may  not  be  so.  but  it  sometimes  seems 
that  they  take  pleasure  in  such  times  as  those  were.  They  look  upon  every 
opportunity  for  doing  good  as  a  blessing  to  themselves.  Did  not  this  happiness 
come  to  them,  how  could  they  devote  their  lives  to  such  work? 

"The  Sun  of  Monday,  November  25,  1S7S,  gives  an  account  of  the  presentation 
to  Dr.  J.  J.  Gordon  of  a  gold  medal  in  recognition  of  his  very  faithful  services 
during  the  prevalence  of  the  feveV.  The  presentation  took  place  at  the  Arlington 
House,  afterward  The  Illinois,  and  now  The  Marion.  It  gives  the  names  of  the 
thirty-five  donors,  and  speaks  of  Mayor  Winter,  the  Rev.  Mr.  George  and  other 
persons  present." 

A  yciifral  rcpcirt  on  the  yellow  fever  epidemic  of  is^s  at  Cairo  \\;is 
made  by  Dr.  Wm.  R.  Smith,  .Sr.,  (.)f  Cairo,  Illinois,  to  Dr.  John  R.  Ranch. 
President  of  the  State  Board.  Dr.  Smith  was  a  practicing  physician  in 
Cairo  at  the  time  of  the  epidemic,  and  speaks  from  experience  inasmnch 
as  In-  reni.iined  in  the  infected  territiu-y  thron^hont  the  entire  ontljri'.-il^  .-md 
took  ;i  lu-KJic  ]iart  in  administering  to  the  sick,  and  later  as  an  inspector  at 
Station  :!  in  the  Cairo  district. 


330 


IIKAl.Tll    CONDITIOXS   AKTF.K    1877 


In  >uiiiiiiint;  u])  liis  (ilisurvaliuns  in  regard  to  the  eindcinic.  Dr.  Smith  re- 
jiortcd  in  part,  as  I'ulliiws : 

"Cairo  is  situated  at  the  confluence  of  the  Mississippi  and  Ohio  Rivers 
at  an  elevation  of  325  feet  above  the  sea,  in  latitude  37,  longitude  S9.12.  Its  site 
is  from  eight  to  15  feet  below  high-water  mark,  and  to  protect  it  from  overflow. 
is  surrounded  by  a  levee.  During  high-water  in  either  river,  all  the  low  ground 
within  the  levee  is  covered  with  "seep  water'  from  one  to  six  feet  deep.  To  prevent 
th  collection  of  rain  water  and  to  remove  the  'seep  water,'  large  sewers  underlie 


Commerial  and  Washington  Avenues,  with  outlets  Into  the  Ohio  River.  Opposite 
Cairo,  on  either  side,  are  extensive  swamps,  and  all  the  land  for  eight  to  ten  miles 
is  subject  to  overflow. 

()i  Aii.v.NTi.NK:  "On  July  29,  1878,  the  city  Board  of  Health  established  a  quar- 
antine by  visitation.  All  steamers  from  the  South  were  visited  by  a  physician, 
and  if  all  were  well,  were  permitted  to  land.  Also  all  trains  were  visited.  Dur- 
ing the  quarantine,  the  steamer  'Porter,'  from  New  Orleans,  landed  here  and  dis- 
charged her  crew,  shipped  another,  and  went  to  St.  Louis.  One  of  the  crew  died 
at  the  hospital  on  Walnut  Street,    (see  map),  August  the  12th. 


HEALTH    CONDITION'S   AFTER    18T7 


331 


"In  about  a  week  the  'Porter'  returned  from  St.  Louis  with  several  cases 
of  yellow  fever  on  board.  Part  of  her  crew  again  left  her  here  and  she  went 
up  the  Ohio  River,  spreading  death  wherever  she  touched.  After  the  fever  became 
epidemic  at  Memphis  and  Granada,  no  steamers  were  permitted  to  land  and  all 
trains  were  stopped  at  Cairo.  There  were  two  violations  of  quarantine  by  steam- 
ers the  'Jas.  D.  Parker'  and  'Ratesville.'     One  of  the  passengers  on  the  'Parker,' 

a  Mr.  C ,  landed  here  and  died  of  the  fever  at  C,  on  Poplar  Street,  August 

24th   (see  map). 

METEROLOGicAi.:  "The  year  ISVS  will  be  in  after  years  reverted  to  by 
'the  oldest  inhabitants'  as  'the  hot  year.'  Its  winter  was  very  mild  and  we  had 
a  summer  temperature  during  its  spring.  The  summer  was  excessively  hot.  And, 
furthermore,  the  high  temperature  was  distributed  over  a  wider  belt  than  usual. 

"The  following  table  shows  the  mean  and  highest  thermometer,  humidity,  pre- 
vailing winds  and  rainfall  at  Cairo  during  the  months  of  June,  July,  August,  Sep- 
tember, and  October,  1S7S: 


Thermometer. 

Humidity. 

"Wind. 

Rainfall. 

Mean. 

Highest. 

June 

July 

74 
83 
81 
76 
59 

89 
96 
94 
88 
81 

69 
■79 
70 
70 
69 

S. 

N. 

S.  W. 

s. 

S. 

4.6  inches 
2.81  inches 
3.45  inches 

September 

2.99  inches 
2.59  Inches 

"The  above  table  shows  that  we  had  for  four  months  a  temperature  and 
just  about  enough  moisture,  to  maintain    1  if  not  generate)    yellow  fever. 

"Although  the  quarantine  was  as  perfect  and  as  stringent  as  it  was  possible 
to  make  it,  w^ith  so  much  shore  line  to  guard,  violations  of  it  by  individuals  were 
quite  frequent, 

thp:  begixnixc;     "The  first  local  case  of  yellow  fever  was  J.  M taken 

on  September  7;  next  T.  N September  8;  next  J.  C September  12: 

next  J.  S September  13.     T.  N was  editor  of  the  Bulletin,  and  the 

other  three  were  printers  who  worked  in  the  same  building   (see  B.  B.  on  map). 

There  were  no   more   cases  until   the  21st.   when   M.   H.   M was  taken  at   1, 

The  fever  then  gradually  spread  from  the  Bulletin  center  B.  B.  to  2,  3,  4,  5,  6, 
7,  8,  9.  On  the  25th  of  September  a  case  occurred  at  M.  on  21st  Street,  and  from 
that  center  the  fever  spread  so  fast  that  it  is  impossible  to  give  names  or  location 
of  cases,  but  the  black  on  map  will  show  the  extent  of  territory  it  took  in. 

"From  whence  came  the  fever?     T.  N visited  C who  died  on 

Poplar  Street,  and  15  days  afterward  M was  taken  with  the  fever,  and  in 

16  days  afterward  N was  taken,  and  in  20  and  21  days  C and  S 

were  attacked.  They  were  all  employed  on  the  Bulletin  and  worked  in  the  same 
room. 

"So  we  may  safely  say  that  the  yellow  fever  was  brought  from  Memphis  by 
the  steamer  'Jas.  D.  Porter.'  " 

The  quarantine  establi.shed  b\-  ihe  State  I'.nard  oi  1  lealtli  practically 
exckided  everything  that  came  from  the  south  unless  it  passed  inspection. 
The  transportation  of  freight  and  jiassengers  across  the  Ohio  River,  between 
Fillmore,  Kentucky,  and  Cairo  was  also  subjected  to  the  same  regulations. 

Thousands  of  fugitives  fnmi  Mrinph.is  and  below  were  allowed  to  come 
into  Illinois  and  Missouri,  and  althoui;h  :iS  ni  these  died  of  the  disease  in 
Illinois,  there  was  not  a  single  case  Cdutracted  from  refugees  nor  their  ctTects 
outside  of  Cairo. 


33"^  iiicAi.rii  coMiriio.Ns  aft:;r  18TT 

'l"lu-  r(.-ii(irls  lu  the  SiaH'  I'.danl  ni  Health  sIkiw  that  li'i  otiieially  report- 
ed deaths  tnmi  \ellii\v  fe\-er  neeurred  ihiriiii;  the  oulhreak  at  Caird.  I''ivc 
cases  and  three  deaths  friiin  l"e\er  occurred  at  Centraha.  100  miles  north 
of  Cairo,  anioni;  those  who  were  t-n^a.^ed  in  transhiijjjini^  hides  from  Siireve- 
]>ort.  Louisiana.  ( )ne  fatal  case  was  reported  from  Rockford.  Illinois.  The 
history  of  this  case  was  that  the  hnshand  C(]ntracted  yellow  fever  and  died 
in  Mecattir,  ,\lahama.  'The  wife  niu'sed  him,  ami  the  day  after  he  died  she 
riiiirned  to  h.er  home  in  Rockfoiil  and  died  in  one  week  of  yellow  fever,  con- 
tracted in    Decatur,  .\lahama. 

After  Ihr  Cairo  Oiithrnih. 

Follow  ini;  this  tragic  experience  in  IS^S.  the  Board  of  Health  was  al- 
ways on  iLjuard  in  suhst'{|Uent  \-cars,  to  ]}revent  the  recurrence  of  this  dread 
disease.  In  ls;it.  Dr.  |ohn  11.  Ranch  wa--  ap]>ointed  delegate  from  the  Illi- 
nois State  r.oard  of  Health  to  attend  tln'  meetin;j;  at  Memphis  on  .\])ril  :iO, 
of  the  various  state  hoards  of  health  in  the  S(juth.  to  consider  the  hest 
methods  for  the  control  of  the  yellow  fever  scourge. 

Rules  and  regulations  recommended  hy  the  National  Hoard  of  lledth 
were  aclopted  to  secure  the  hest  sanitary  condition  of  steamboats  and  other 
ve.ssels,  railroads,  their  station  houses,  cars,  freight,  and  passengers. 

.\  system  of  sanitary  ins])ection  was  maintained  in  the  southern  part 
of  the  State.  One  sanitarv  policeman  was  stationed  at  Mound  L'ity,  and  two 
at  C'airo.  One  medical  inspector  w.as  a|i|"iinleil  to  assist  in  carrying  out  the 
rules  and  regulations  of  the  State  llo.ird  of  Health.  Dr.  Frank  \V.  Ixeilly 
was  appointed  sanitary  inspector  July  28  and  stationed  at  East  Cairo.  Dr. 
\\".  R.  Smith  of  Cairo  was  ajipointed  insjiector  and  assigned  to  Station  Xo.  3. 
Cairo,  July   I. 

Dr.  |ohn  11.  l\auch  was  electe  1  secretary-treasurer  of  an  interstate 
organization,  known  as  The  Sanitru'y  t/ouncil  of  the  Mississippi  \'alley.  The 
function  of  this  organization  was  to  kee])  health  officers  in  all  states  within 
the  \ello\v  fever  zone  informed  concerning  outbreaks  of  epidemic  diseases, 
particularly  of  yellow  fever,  and  to  make  rules  and  regulations  which 
w-ere  expected  to  be  adopted  liy  all  the  member  health  officers. 

The  Hoard  adopted  rules  and  regulations  concerning  yellow  fever,  re- 
(|uiring  critical  inspection  of  health  certihcates  of  passengers  on  trains  and 
boats.  The  regulations  concerning  the  inspection  of  boats  were  strictly  en- 
forced. In  regard  to  these  the  ca])tain  of  the  "Belle  St.  Louis"  remarked: 
"H  it  wasn't  for  these  insj)ections,  boats  wouldn't  be  paying  expenses — 
they'd  be  shut  off  of  so  many  ports,  now  open  to  them  on  account  of  their 
health  bills." 


HEALTH   COXDITIONS  AFTER    18TT  333 

The  report  of  a  single  case  of  mellow  fever  in  the  south  caused  a  shrink- 
age of  the  provision  market  in  Cliicago  alone,  which  amounted  to  a  million 
dollars  within  24  hours. 

.\  sunimarv  of  the  (juarantine  measures  taken  against  yellow  fever  in 
liSTIt,  is  contained  in  the  following  letter  to  the  Mayor  of  Cairo,  giving  in- 
structions as  to  necessary  precautions: 

"Sir: 

"In  transmitting  the  accompanying  summary  statement  of  inspection  and 
other  service  at  the  Quarantine  Inspection  Station.  Mississippi  River,  below  Cairo, 
during  the  season  this  day  closed,  the  Illinois  State  Board  of  Health  begs  to  ex- 
press its  appreciation  of  the  aid,  both  material  and  moral,  which  the  National 
Board  of  Health  has  rendered  it  in  protecting  the  State,  possibly  not  from  an 
invasion  of  yellow  fever,  but  most  assuredly  from  such  interruption  of  travel 
and  traffic  as  have  hitherto  uniformly  followed  a  threatened  invasion  of  that 
disease.  Precisely  what  such  interruption  amounts  to  it  would  be  difficult  to 
state  in  dollars  and  cents;  but  an  inkling  of  it  is  given  in  the  figures  in  the  sum- 
mary statement,  from  which  it  will  be  seen  that,  whereas  the  average  vessel 
tonnage  arriving  from  below  at  the  time  the  inspection  system  was  begun,  amount- 
ed to  only  967.66  tons  per  diem,  it  had  risen  to  2.166.67  tons  per  diem  during  the 
last  31  days,  and  this  in  spite  of  an  unusually  low  stage  of  water.  La^t  year  the 
commerce  of  the  port  at  Cairo  during  the  month  of  October  amounted  to  only 
48,967  tons  northwise  and  eastwise  as  well  as  southwise.  while  this  year  it  amounts 
to  87.127  tons  for  the  same  period.  (The  tonnage  of  barges,  lighters  and  Hats 
is  not  included  in  these  figures,  while  it  is  in  the  figures  in  the  summary  state- 
ment.) 

"During  the  period  while  the  Inspection  Station  was  in  commission  this  year. 
1.162  vessels  of  all  kinds  (exclusive  of  barges,  lighters  and  flats)  entered  at  the 
port  of  Cairo:  as  against  only  707  vessels  during  the  same  period  last  year:  and 
notwithstanding  this  quarantine  of  exclusion  in  1S7S,  yellow  fever  obtained 
access  to  the  port  with  a  total  mortality  of  62  recorded  deaths.  This  year  not  a 
single  case  of  the  disease  has  developed  among  the  3,098  persons  allowed  to  come 
into  Cairo,  nor  among  the  20,776  persons  passed  through  the  Inspection  Station 
from  below,  notwithstanding  fever  prevailed  at  43  distinct  points  in  the  Valley 
during  the  period. 

"Intercourse  with  all  ports  below  Tiptonville.  Tennessee.  120  miles  south 
of  Cairo,  was  practically  suspended  at  the  port  when  inspections  were  begun;  but 
as  confidence  in  the  system  was  established  by  observation  of  its  workings  and 
results,  one  by  one  the  interdicts  were  removed,  until  by  Sept.  1  the  sole  require- 
ment for  entry  of  passengers  or  freight  into  the  State  of  Illinois  from  southern 
ports,  was  a  clean  bill  of  health  (or  certificate  of  inspection)  from  the  station. 
A  comparison  of  the  figures  shows  the  steady  restoration  of  river  business  from 
below.  In  August.  .56  vessels,  with  an  aggregate  capacity  of  44.966.87  tons,  pre- 
sented themselves  for  inspection;  in  September.  SO  vessels,  with  an  aggre  ate 
capacity  of  57,824.50  tons;  and  in  October.  100  vessels,  with  an  aggregate  capacity 
of  69.667.85  tons." 

The  sum  of  'toOO.OOO  was  appropriated  in  is;;)  and  placed  at  the  dis- 
posal of  the  Xational  Board  of  Health  for  the  control  of  vellow  fever,  of 
which  sum  $!()(), 000  was  wisely  and  successfully  emploved  in  c(.imhaling  the 
epidemic  that  year. 

Measures  to  prevent  the  introduction  of  yellow  fever  from  the  South 
were  continued  in  the  summer  of  l.ssi.  The  Board  ordered  that  after  July 
1.  Dr.  W.  R.  Smith,  inspector  at  Stati(m  No.  :),  helow-  Cairo,  put 
into  commission  said  station  and  that  after  said  station  had  been  put  into 


33-1-  iiiiAi.rii  (oxiirnoxs  ai't;:k  ISTT 

cnmniissinii  llu-  M-crt-larx  of  llic  Slalr  I'.oanl  (if  llcallh  be  directed  to  notify 
tlie  aiuiinrities  cif  all  jxirts  in  ihi^  Stale  noi  to  alUiw  hoats  to  land  from  points 
below  Cairo,  iniless  upon  ])rcscntation  of  a  clean  certificate  of  inspection  as 
to  caryo.  officers  and  crew. 

Till'   Yi  llnir  Frrrr  Srarr  of  ISSS. 

In  tile  fall  of  ISSS  it  was  reported  that  yellow  fever  had  develo]ied  in 
the  south.  The  secretar\-  of  the  Hoard  of  Health  found  it  necessary  to 
niaUe  active  etforts  to  check  the  public  alarm  that  developed  immediately. 
The  \ellow  fever  epidemic  h.id  occurred  in  Florida,  but  it  was  late  in  the 
b'all.  .\e\-ertheless,  millions  df  dollars  were  lost  from  foolish  quarantines, 
interference  of  travel  and  a  general  feeling  of  apprehension,  all  unnecessary 
even  in  the  li.i;hi  of  the  then  known  facts  aljout  yellow  fever. 

It  is  worthy  of  note  that  a  status  of  public  panic  developed  in  southern 
Illinois,  esjjeciallv  in  the  vicinil\-  of  Cairo,  as  a  result  of  reports  of  yellow 
fe\er  in  Decatur,  Alabama,  and  th.il  the  secretary  of  the  Board  spent  several 
days  in  that  vicinitv  resiorins^  public  eonlidence  and  preventitig  a  costly 
qtiarantine  from  being-  uimecess;iiily  set  u|).  The  secretary's  stand  was 
based  upon  meteorological  gimtnds  that  were  sound  and  were  proved  so  by 
subsequent  develojMiients.  iianiely  lh:it  yellow  fever  does  not  spread  to  the 
North  with  the  advent  of  cold  weather. 

Till'  Srarr  ill   1807. 

The  next  vellow  fever  scare  was  in  the  fall  of  IS'.);.  The  first  official 
information  of  the  existence  of  yellow  fe\'er  in  the  south,  reached  the  State 
I'xiard  of  Health  on  the  morning  of  Se];tember  7.  Under  the  circum.stances 
it  was  deemed  urgently  necessary  to  establish  immediately  an  inspection  ser- 
vice at  Cairo.  Upon  reporting  the  matter  to  ( ioxenior  Tanner,  he  advised: 
"Secure  services  of  as  many  comiietenl  medical  men  as  may  be  necessary 
and  use  every  endeavor  to  kee]>  \ellow  fever  out  of  the  State,  and  to  control 
its  spread  should  a  case  appeur  in  the  .State.  I'ayment  of  all  expense  incurred 
will  be  approved  by  me." 

On  .September  '-K  1 'r.  I'hillip  S.  Do.ine.  Chicago;  A.  11.  .Maini.  .S|iring- 
fK-ld  ;  and  Dr.  \\  .  V.  (  irinslejid,  (',iiro,  were  ,appointe<l  as  inspectors  to  co- 
operate with  Dr.  John  1!.  Xeeh  of  (hicigo,  surgeon  in  charge  oi  ins|)ec- 
tions,  stationed  at  Cairo. 

.\  rigid  system  of  inspection  was  inaugurated  by  these  officials.  All 
bo.'its  aii<l  trains  coming  into  Cairo  day  and  night  were  met  and  every  pas- 
senger from  infected  districts  inspected.  During  the  period  of  Cairo's  quar- 
;uuine,  tr.iin  inspt'ction  was  c.nrried  out  in  Chicago  chiefly  as  related  to  thor- 
ough disinfection  of  tr.ains  from  the  South,  with  chief  attention  to  those  of 
the  Illinois  Central  Railroad. 


HEALTH   COXDITIOXS  AFTER    ISTT  335 

Quarantine  and  inspectinn  service  in  Cairo  was  maintained  frdui  Sej)- 
teniber  9  to  September  30,  l.S'.i;,  ti)  prevent  the  sjjread  of  and  danger  from 
infection  of  yellow  fever,  which  was  at  this  time  very  prevalent  at  the  var- 
ious southern  ])oints,  chiefly  New  Orleans,  jMohile.  and  Atlanta.  From  Sep- 
tember ■;  to  30,  14T  trains,  ri.lOT  passengers  on  trains;  ]2  steamboats,  and 
57(1  passengers  on  steamboats,  were  insi)ected.  On  Sejjtember  1!).  Dr.  C.  S. 
Nelson.  Springfield,  and  Dr.  J.  C  l'"ults.  Waterloo,  were  appointed  as  sani- 
tar\'  insiiectors  to  assist  Dr.  Neely  in  enforcement  of  quarantine  against 
velliiw  fever. 

( )n  September  1!)  two  cases  of  yellow  fever  were  reported  at  Cairo,  and 
two  more  on  the  following  day.  The  fliagnosis  of  yellow  fever  in  these  cases 
was  disputed  by  the  ])eople  of  Cairo,  and  liy  a  majority  of  the  local  physi- 
cians. Man\-  citizens  and  a  few  physicians  also,  declared  that  yellow  fever 
ciiuld  not  exist  in  Cairo  at  that  lime  n\  year.  That  there  was  no  analogy 
between  the  appearance  of  this  disease  and  the  season  of  the  year  did  not 
occur  to  those  taking  exception  to  the  diagnosis.  .\  case  of  yellow  fever  can 
occur  in  anv  ])art  of  the  State  of  Illinois  at  any  period  of  the  year.  The 
(li^ea^e  will  not  spread.  h(iwe\er.  at  certain  lemperatm-es,  and  parenthetically, 
ii  will  not  spread  under  the  climatic  cnndiiidus  most  favorable  to  its  propa- 
gation if  ])roper  sanitary  conditions  are  fouiKl  ,ind  the  patients  are  kept 
isolated. 

The  following  statement  seems  to  remove  all  duubt  that  true  cases  of 

vellow  fever  existed  in  Cairo  in  lSi)7  : 

"Dr.  John  Guiteras.  of  the  Marine  Hospital  Service,  arrived  in  Cairo  from 
Mobile  on  Sunday,  September  19th.  After  an  examination  of  the  patients,  P.  J. 
Reynolds  and  M'ichael  Ryan,  he  pronounced  the  disease  yellow  fever.  Dr.  Guiteras 
stated  that  the  disease  prevailed  in  a  mild  form,  and  as  the  patients  were  convales- 
cing and-  all  precautions  to  prevent  the  spread  of  the  malady  had  been  taken, 
he  was  of  the  opinion  that  there  would  be  little  danger  of  infection.  He  advised 
a  continuance  of  the  quarantine  effected  until  the  patients  were  entirely  well." 

It  is  of  more  than  jjassing  interest  to  muc  that  higli  temperatures  exist- 
ed in  ISD;  as  well  as  in  l.ST<S,  as  proven  by  the  following  telegram  dated 
(.)ctober  'i  sent  to  the  Secretary  by  ex-Sui'geon  of  the  Marine  Ilosjiital  Ser- 
vice, Mr.  John  K.  Hamilton,  of  Chicago: 

"I  advise  sticking  to  present  regulations  until  lower  temperature.  Cairo  is 
still  the  danger  point,  and  refugees  from  infected  districts  cannot  with  safety 
be  allowed  to  enter  the  city." 

The  following  comment  would  indicate  a  yellnw  fe\er  scare  in  ISilS: 
"The  appearance  of  yellow  fever  in  Ocean  Springs,  and  its  rapid  spread  to 
other  cities  of  the  south  gave  rise  to  well-grounded  apprehensions  that  the  disease 
might  reach  Illinois,  and  notwithstanding  the  lateness  of  the  season,  prevail  in 
epidemic  form  in  the  cities  of  the  southern  part  of  the  State,  Cairo  especially.  *  *  *" 
"The  danger  to  which  the  state  was  exposed  in  September.  1S7S,  was  not 
fully  realized  until  too  late.  Even  the  distinguished  President  of  the  State 
l?ourd  of  Health,  apparently  saw  little  reason  to  apprehend  danger  at   this  time, 


33G  HEALTH    fONllITJONS   AFTF.K    18TT 

ami  confident  that  the  lateness  of  the  season  also  precludeil  the  possibility  of  an 
outbreak  of  yellow  fever  in  Illinois,  he  counseled  against  the  very  quarantine  re- 
strictions which  one  year  later  during  the  same  month  of  the  year  he  strongly 
advised.  Even  while  the  disease  was  at  its  height  in  Cairo  early  in  September, 
1878,  he  pronounced  'the  panic  unwarranted'  and  expressed  the  opinion  that  'the 
end  must  be  near.'  " 

Sanitary  iii'-prctor.  Dr.  Jaiiie.s  de  Courcy.  was  detailed  for  duty  at  Cairo 
on  October  1.  to  enforce  (|iiarantine  regulation.s  against  passengers  and  rail- 
roads in  the  vicinity  of  C  airo.  'I'he  (luarantine  restrictions  were  raised  and 
insjjection  service  was  terminated  on  October  IS,  1,S!)8. 

'Jlic  Scare  of  1!i().'>. 

b'fnni  lS!i,s  1(1  i;((i."i.  tbe  Illinois  State  Board  of  Health  records  are  free 
of  anv  ^care  of  ycUnw  fever  until  1905.  Late  in  July,  l!i()5,  yellow  fever  was 
reported  in  iiKirc  or  less  epidemic  form  at  New  Orleans.  The  secretary.  Dr. 
James  .\.  I'Lgan,  left  at  once  for  Cairo,  where  he  investigated  the  sanitaiy 
condition  of  the  city  and  proceeded  to  Memphis  where  he  ascertained  that 
a  qnarantine  against  New  Orleans  had  already  been  established  and  thnt 
the  situation  was  far  more  dangerous  than  comnionly  supposed. 

The  secretary  determined  to  establish  a  train  inspection  service,  and 
from  the  first  of  August  every  train  antl  steamboat  coming  from  the  sotith 
was  boarded,  and  every  ])assenger  ins])ected.  and  only  those  permitted  to 
land  in  tbe  southern  part  of  Illinois  who  could  present  proper  credentials 
from  health  authorities  and  evidence  as  to  his  recent  whereabouts.  Com- 
]ieteiit  medical  men  were  employed  for  this  service. 

Within  a  short  time  after  the  establishment  of  train  insjjection,  the  con- 
ditions in  the  south  grew  so  much  more  seriotis,  that  the  City  Council  de- 
clared a  rigid  quarantine  against  the  south  and  admitted  travelers  only  upon 
the  presentation  of  permits  issued  at  Cairo.  Anticipating  the  invasion  of 
the  city  by  yellow  fever  patients,  a  well-ec|uipped  isolation  hospital  was  estab- 
lished in  a  houseboat,  and  under  the  care  of  a  com])etent  attendant,  the  boat 
was  ready  to  be  taken  to  a  point  of  safety  in  midstream.  It  was  not  neces- 
sary to  use  this  boat. 

Rigid  t(uaratitine  was  maintained  from  August  .'i  until  October  K. 
Nine  inspectors  were  employed  and  several  watchmen.  During  this  time 
hundreds  of  ]:ersons  coming  from  infected  points  were  diverted  in  other 
direct ioii>.  ;ind  in  this  manner,  the  State  was  saved  from  an  invasion  of  fever. 

It  is  gr;itifving  to  report  that  regardless  of  the  inconvenience  and  conse- 
quent de])re>sion  of  trade,  the  people  of  Cairo  were  in  sympathy  with  the 
erf<irts  of  the  State  Hoard  and  expressed  appro\al  of  the  work  and  the  man- 
ner in  which  it  was  conducted. 

Dr.  George  Thomas  I'almer,  stmitary  a->.^istant  of  the  Ho.ard,  was  placed 
in  charge  of  the  qtiarantine  service  at  Cairo,  dtiring  the  enforced  absence  of 


338  IIKAI.TII    fOXDI  TKINS  A  I- '1' i:  K    ISTT 

the  sccrt-tary.  In  rcs])()nse  to  the  \erv  e\i(leiit  need  of  such  an  officer  who 
could  relieve  the  secretary  of  sonii'  of  the  details  of  the  work  of  the  of^ce, 
the  General  Assenihlv  had  made  an  a|ii>ro|)riation  tor  an  assistant  secretary, 
which  went  into  effect  on  July  1,  llio."..  In  order  that  Dr.  I'alnier  niitjht  have 
greater  anth(  rity  in  the  performance  of  his  duties  at  Cairo,  the  secretary 
ai)[)ointed  him  as  assistant  secretary  to  the  State  Hoard  of  Health  and  asked 
for  the  apj^roval  of  the  luiard,  which  was  L;ranted. 

Typhoid  Fever. 

In  followint;  the  history  of  the  rise  and  fall  of  t\'i)hoid  fever  in  Illinois, 
the  theorit's  prevailing,'  at  various  times  in  regard  to  its  cause  must  he  kept 
in  mind. 

The  views  as  to  the  origin  of  the  disease,  and  the  early  theories  in  re- 
gard to  its  cause,  are  set  forth  in  the  preceding  part  of  thi>  volume.  For 
au  understanding  of  the  preventive  measures  taken  to  control  typhoid  fever 
since  the  establishment  of  the  State  Board  of  Health  in  is';?,  reference  is 
here  made  only  to  the  theories  and  facts  in  regard  to  its  course  and  transmis- 
sion of  the  disease,  generally  accepted  for  varying  periods  since  that  time. 

When  the  Board  was  first  established,  typhoid  fever  was  tmiversally 
looked  upon  as  a  filth  disease.  The  typhoid  bacillus  was  not  discovered  until 
ISso,  when  it  was  first  found  in  the  tissues,  by  Ebert,  and  was  not  isolated 
until  four  years  later,  when  GafYky  grew  it  in  pure  culture.  Although  this 
and  the  other  great  discoveries  in  liacteriology  were  made  in  the  early  eight- 
ies, they  were  not  generally  accepted,  nor  did  they  modify  the  prevailing 
views  in  regard  to  the  control  of  communicable  diseases  to  any  great  extent, 
until  the  middle  nineties, 

W  hat  the  prevailing  views  of  practicing  physicians  were  during  the  first 
1.5  vears  of  the  Board's  existence  is  shown  from  the  following  statement  in 
regard  to  typhoid  fever  bv  Dr.  X.  S.  Davis  in  his  Lectures  tni  the  Principles 
and  Practice  of  Mecliciiie.  published  in  ISSl  : 

"A  careful  adherence  to  well  ascertained  facts  concerning  the  etiology  of  ty- 
phoid fever  will  require  us  to  accept  the  three  following  propositions: 

"  'First,  that  cases  of  typhoid  originate  in  dwellings  or  buildings  of  any  kind 
in  which,  from  either  overcrowding  the  number  of  occupants,  or  the  neglect  of  ven- 
tilation and  cleanliness,  the  air,  furniture,  and  walls,  become  strongly  impregnated 
with  the  organic  matter  exhaled  from  the  skin  and  lungs  of  the  occupants,  *  *  *  * 

"  'Second,  that  the  more  the  soil  of  any  given  locality  becomes  impregnated 
with  the  intestinal  and  urinary  excretions  by  progressive  increase  of  the  density 
of  the  population  provided  the  two  conditions  of  drainage  and  water  supply  remain 
the  same,  the  more  frequent  and  severe  will  be  the  cases  of  typhoid  among  the 
inhabitants  of  such  locality.  *  *  * 

"  'Third,  cases  of  genuine  typhoid  have  occurred  and  are  still  occurring  occa- 
sionally in  every  civilized  community,  in  persons  who  have  had  no  traceable  com- 
munication with  previous  cases  of  that  disease,  or  with  any  of  the  recognized  or 
suspected  sources  of  infection.  *  *  *  • 


HEALTH    CONniTIONS   AFTER    187  7  339 

"  'Probably  no  fact  is  better  established  than  that  the  disease  under  consider- 
ation generally  originates  from  the  use  of  air  or  water  impregnated  with  some 
one  or  more  of  the  products  derived  from  the  decomposition  of  organic  matter. 
It  does  not  follow,  however,  that  such  prodiict  of  organic  change  must  necessarily 
be  formed  outside  of  the  human  body.'  " 

Dr.  Davis  was  a  leafier  of  the  liical  medical  profession  at  the  lime,  and 
had  heen  active  in  many  movements  for  sanitary  reform  in  the  city  n\  Clii- 
cago  and  the  State,  conseqnenth-  it  may  Ije  ])resume(l  that  his  views  are  rep- 
resentative of  the  time. 

The  views  held  were  doubtless  Ijased  on  those  expressed  by  Dr.  Charles 
Murchison  in  1.S62,  as  enunciated  in  his  famous  theory  of  the  pythogenic 
origin  of  typhoid,  which  held  that  it  is  "generated  and  probably  propagated 
by  certain  forms  of  decomposing  matter."  In  the  succeeding  25  years  the 
facts  were  tortured  in  every  conceivable  manner  to  fit  this  theory.  Some- 
times the  incubative  period  of  the  di.sease  was  shortened  to  a  few  hours  when 
it  "immediately  followed"  exposure  to  certain  fetid  contaminations.  A 
favorite  way  of  accounting  for  an  epidemic  was  the  finding  of  defective 
drains  or  nearby  privy  vaults,  cess  ]i()oIs  or  decaying  matter  of  any  kind. 

Some,  who  had  been  im])resse(l  with  Pettenkofer's  observations  on 
cholera,  leaned  strongly  towards  ground  water  and  deteclivc  drainage  of 
the  soil  as  a  factor  in  the  jiroduction  of  i\|ihoid.  -\n  examjile  of  such  a 
view  is  that  expressed  by  Health  Commissioner  Ware  of  Chicago  in  explain- 
ing the  cause  of  the  greatest  typhoid  e])idemic  in  the  history  of  the  city, 
namely  that  of  1S!»1  and  1S!I2.  In  his  annual  rejMrt  to  the  mayor  for  the 
year  1SI)2,  he  says:  "We  have  typhoid  fever,  and  always  will  have  so  long 
as  there  remains  so  much  tmdrained  projjerty." 

In  the  Sanitarian,  a  leading  British  publication  on  sanitary  science,  ap- 
peare<l  the  following  statement  in  ISSO:  "Typhoid  fever  is  traceable  to 
tilth  with  as  nnich  certainty  as  smoke  is  to  fire." 

Imliueil  with  these  ideas,  Ranch,  as  secretary  and  executive  officer  of 
the  State  Hoard  of  Health  dotlbtless  believed  that  in  prosecuting  his  great 
scheme  of  a  general  sanitary  sur\cy  of  the  ."^tale,  sl.irted  after  the  threatened 
invasion  of  cholera  in  ISS:!,  that  Ik-  was  killing  a  whole  flock  (if  Ijirds  with 
one  stone. 

rulilic  sentiment  favored,  and  in  fact,  demamled  that  something  be  done 
to  ]ire\ent  tlu-  invasion  of  cholera.  Approprialii  ns  were  imgrudgingly  given 
by  the  .'^tate  and  local  authorities  for  such  work,  and  thus  Ranch  had  the 
op])ortimity  of  his  lifetime  to  do  what  to  him  nuist  have  seemed  an  effective 
drive  to  rid  the  State,  net  only  of  cholera,  but  of  all  filth  diseases. 

The  following  comment  of  the  .Vcti'  )'(irk  Medical  Board  is  ])eninenl 
to  this  i|uestion : 

"There  is  no  doubt  tliat  the  extra  clcanlinet-s  produced  by  the  cholera  scare 
(1878)  will  effect  a  saving  of  life  from  other  filth  diseases,  far  in  excess  of  the 
mortality  from  cholera  itself,  unless  it  should   be  spread  beyond  all  expectation." 


340 


IIRALTH    COXIHTIOXS  Al"n'.U    1877 


TiiphduJ  IliUuUid  (IS  a  Filth  Disease. 

lln-  tiiiK'  (luring-  wliicli  ivplinid  fever  was  considered  a  filth  disease 
and  measures  for  its  control  were  conducted  with  ihi>  end  in  view,  includes 
the  pericd  of  activities  of  the  State  Board  of  llealth  frcmi  its  estahlishnient 
in  1877  to  approximately  the  time  of  the  World's  Fair  in  Chicago,  in  1893. 

The  official  records  of  the  Board  prior  to  18S)U,  show  that  no  special 
attention  was  given  to  the  cintrol  of  ly])h()id  fe\-er,  outside  of  the  extensive 
general  campaign  waged  to  clean  u])  the   State. 


Tahle  28. 
C.^SEs  OF  Typhoid  Fever  Reported  in  Illinois. 


Year. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

.Tune. 

Jul.v. 

Aug. 

Sept. 

Oct. 

Xov. 

Dec. 

Total. 

1917 

115 

132 

109 

253 

91 

73 

186 

405 

637 

193 

94 

55 

2,342 

1918 

89 

82 

55 

52 

51 

64 

212 

241 

286 

102 

24 

86 

1,344 

1919 

33 

33 

39 

47 

32 

64 

265 

294 

306 

346 

251 

183 

1,893 

1920 

124 

80 

88 

115 

103 

138 

162 

211 

284 

257 

198 

109 

1,869 

1921 

96 

74 

83 

89 

72 

152 

336 

443 

419 

392 

185 

82 

2,423 

1922 

79 

73 

81 

74 

135 

116 

182 

255 

254 

273 

173 

103 

1,798 

1923 

65 

31 

89 

52 

54 

68 

99 

233 

320 

259 

315 

277 

1,862 

1924 

159 

72 

43 

59 

63 

63 

124 

168 

191 

176 

125 

231 

1,474 

1925 

119 

71 

62 

58 

71 

124 

217 

298 

297 

310 

206 

297 

2,130 

1926 

111 

50 

44 

44 

34 

65 

106 

214 

303 

386 

203 

113 

1,677 

1927 

52 

62 

39 

40 

52 

70 

141 

1.. 

. 

I 



1 

Tahle  29. 
Deaths  fro.m  Tvpiuud  Fever  in  Illinois. 


Year. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

July. 

Aug. 

.Sept. 

Oct. 

Nov. 

Dec. 

Total. 

1918 

26 

37 

24 

21' 

33 

27 

37 

84 

75 

86 

44 

39 

533 

1919 

29 

IS 

19 

9 

22 

13 

35 

37 

52 

41 

45 

41 

383 

1920 

35 

24 

22 

12 

15 

IS 

38 

34 

53 

58 

47 

24 

380 

1921 

23 

19 

17 

10 

15 

32 

43 

33 

56 

65 

40 

23 

396 

1922 

18 

15 

16 

12 

23 

10 

21 

33 

33 

38 

32 

29 

282 

1923 

17 

12 

13 

12 

14 

8 

28 

45 

48 

43 

31 

46 

317 

1924 

33 

9 

13 

10 

6 

22 

23 

17 

37 

23 

43 

241 

1925 

24 

5 

11 

7 

11 

19 

32 

60 

55 

43 

31 

29 

327 

1926 

9 

4 

5 

9 

6 

24 

30 

37 

44 

41 

14 

230 

The  mortality  records  that  were  collected  from  1880  to  1886,  incom- 
plete a^  lhe\-  adniilledh-  are,  show  an  annual  average  of  1,335  deaths  from 
t\pli<iid  in  the  entire  State.  \\  hen  from  this  numhcr  are  deducted  418,  which 
is  the  a\erage  aiinii.il  nunilier  (jf  t\phi;id  ileaths  recorded  in  Chicago,  it  is 
fouiul  that  li-.".'  deaths  were  recurded  f(ir  the  other  .sections  of  the  State,  a 
figure  so  small  as  to  lie  hardlv  prohahle,  in  \  iew  of  the  fact  that  other  evi- 
dence shows  that  typlioid  fever  was  (|uile  prevalent  in  Chicago  as  well 
as  (lownstate  during  this  time. 


HEALTH   CONDITION'S  AFTER    ISTT  341 

In  ISST  conditions  dnrinu;  the  sunmu'r  caused  the  Board  to  express 
grave  solicitude  in  reijard  to  tile  liealth  outluok  for  the  State.  Intensely 
licit  weather  in  July  and  the  prolontjed  (lrnn.i;ht  were  among  the  more  im- 
jiortant  causes  of  this  fear.  The  great  [irevalence  of  diarrheal  diseases  and 
numerous  outbreaks  of  typhoid  fe\er,  the  former  directly  due  to  high  tem- 
perature, and  the  latter  intensified  hv  water  supplies  affected  bv  the  drought, 
were  noted  during  the  summer. 

.\n  outbreak  of  typhoid  occurred  in  February  and  March,  ISSi),  at  Con- 
cordia College.  Springfield,  resulting  in  "^'1  cases  and  two  deaths  among 
students.  The  cause  of  the  outbreak  was  altriliuted  to  the  use  of  drinking 
water  taken  from  a  well  located  near  a  privy. 

Twenty  cases  of  the  disease  with  four  deaths  occurred  in  IS'.KI  among 
students  of  Augustana  College,  Rock  Island.  The  outbreak  was  reported 
due  to  defective  drainage  and  plumbing.  An  especially  virulent  typhoid 
infection  in  a  family  of  eleven  near  Urbana,  with  nine  deaths,  was  reported. 
Also  another  instance  in  the  same  locality  of  seven  cases  in  one  family  of 
nine  children,  with  two  deaths. 

Bacteriologic  Period. 

Bacteriology  was  pretty  well  estalilished  in  the  early  nineties.  From 
this  time  on  typhoid  fever  was  no  longer  considered  as  a  necessary  evil.  /Vt- 
tention  was  given  to  gross  pollution  of  w'ater  supplies  in  the  handling  of 
epidemics.  The  disease  was  also  made  reportable.  A  more  accurate  means 
of  diagnosis  was  offered  by  the  Widal  test. 

These  illustrations  indicate  ver\-  well  how  widelv  jirevalent  typhoid 
fever  was  prior  to  1900  in  Illinois.  Xeiiher  cities  nor  rural  districts  es- 
caped although  the  cities  suft'ered  worse  because  of  common  water  supjilies 
through  which  the  disease  was  transmitted.  In  Cliicago.  for  instance,  a  long 
drawn-out  epidemic  stretching  over  three  years  began  in  1890,  resulting  in 
no  less  than  4,494  deaths.  It  attracted  particular  attention  because  of  the 
World's  Fair  scheduled  for  IMKi.  \'er\-  exh;ui<tiye  investigation  of  the  water 
suppK'  followed,  bringing  about  such  elTorts  at  purification  as  was  possible  at 
the  time. 

Situations  like  these  were  common  and  iire\'ailed  continuously  until 
sanitarians  and  the  ])ublic  came  to  recognize  and  appreciate  the  liacteriolog- 
ical  character  of  typhoid  fever.  As  soon  as  clear  conception  of  these  facts 
became  established  typhoid  fever  started  to  decline  in  Illinois. 

These  activities  were  reflected  at  once  in  substantial  declines  in  tyi>hoid 
fever  rates.     How  rajiid  the  rates   fell  is  illustrated  in   Figure  19. 

I'roni  about  1900  on  outbreaks  of  typhoid  fever  drew  attention  first  to 
local    water   supplies.      Mimicipalilies    (klayed    the    insl;illation    of    adequate 


342 


IIEAI.TII    CONDITIONS  AFTF-K    IS,, 


ptililic  watiT  sii]i])lv  .sati-t;uar(ls,  as  a  rule,  uiilil  an  i-|>i(lcinic  fell  upon  them 
and  then,  alter  the  enuditioiis  were  pointed  ntit  hv  a  sanitarian,  permanent 
improxements  were  made.  'I'liis  is  ahuut  the  hi>tor\-  of  typhoid  fe\er  until 
about  nijd.  L'])  to  that  time  polluted  water  had  i^jrown  to  he  rei^arded  as 
the  chief  olt't'iidini;  assent  in  the  S])read  of  typhoid.  (  )ne  city  after  another 
went  throut^h  disastrous  or  very  serious  experiences  and  came  ont  with  im- 
jjroved  water  su])|)hes  that  jjrevented  recurrence  on  a  large  scale. 


H-. TYPMOID    FEVER 

in    ILLIhOIS 


HIi  1860-1926 

STATISTICS   LTIAVALABLE    fDR    OPEd  YEARS  ^ 


Period  III  Stisfi'iiKit i<   ('inilrnl. 

With  the  increasing  knowledge  of  typhoid  fever  and  the  study  of  many 
outlirealo  in  all  parts  of  the  world,  the  time  arrived  arouiiil  lUin  when  seri- 
ous efforts  were  made  to  control  all  of  the  factors  which  pla_\-ed  a  role  in  the 
transmission  of  the  disease. 

The  si)read  hy  milk  was  found  to  be  frequent,  and  pasteurization  was 
inaugurated  to  check  it.  Flies  were  given  a  great  deal  of  attention,  and  were 
tomid  to  play  an  im[)ortant  ]:iart  especially  in  rural  coinmunities. 

lliiman  carrier-,  were  detected  as  causes  of  certain  outbreaks,  and  when 
the  iinp(]rtance  was  fully  recognized,  steps  were  taken  to  prevent  this  source 


HEALTH   CONDITIONS  AFTER    18T7  343 

of  infection  by  the  exaniinatidii  df  siouls  and  urine  of  convalescent  cases. 
Contact  infection  was  also  controlled.  especialK'  1)\  in-innniization  and  more 
general  hospitalization  of  cases. 

One  of  the  most  otitstanding^  features  of  typhoid  control  durint;  this 
period  was  the  development  and  ajiplication  of  epidemiologic  methods  for 
the  detection  of  epidemics,  and  tracing  them  to  their  sources,  d'hus  this 
])eriod  is  characterized  by  a  chronicle  of  one  small  local  outbreak  after  an- 
other, discovered,  traced  to  its  source,  and  sto]iped,  with  the  result  that  the 
typhoid  mortality  was  low.  yes,  l."!  or  ",!()  times  lower  than  in  the  previous 
periods,  during  wdiich  such  occurrences  were  much  less  frequently  heeded, 
or  correctly  traced  to  their  origin. 

Table  ;?(). 
Deaths  and   Death   Rates  from   Typhoid  Fever  in    Illinois. 

Riite  I.or 
100,000 
No.  deaths.       iiopuliitioii. 

917  16.5 

1,039  18.4 

893  15.5 

744  12.7 


liate  per 

103,000 

Year. 

No.  deaths. 

population. 

Year. 

1860  

1,183 

65.7 

1909 

1870 

1,758 

70.3 

1910 

1880 

1,652 

53.6 

1911 

1881 

2,082 

66. 

1912 

1882 

1,424 

44.1 

1913 

1883 

1,054 

31.9 

1914 

1,884 

1,066 

31.5 

1915 

1885 

1,379 

39.9 

1916 

1886 

1,689 

47. S 

1917 

1890 

1,700 

44.4 

19IS 

1900 

1,897 

39.3 

1919 

1902 

1,882 

37.7 

1920 

1903 

1,578 

31. 

1921 

1904 

1,300 

25.2 

1922 

1905 

1,047 

20. 

1923 

1906 

1,061 

19.7 

1924 

1907  

1,119 

20 . 5 

1!I1'5 

1908  

914 

17.2 

1926 

Water  supplies  came  under  close  bacteriologic  scrutiny,  and  were  only 

1 iften    found   showing  evidences   of    fecal   jiollution.      .V   great    step    was 

taken  in  the  ])urification  of  such  water  supplies  around  \'J\'>  and  after,  by 
the  use  of  chlorine  in  minute  quantities  as  a  disinfecting  agent. 

Steplike  declivities  in  the  rate  are  noted  following  the  adoption  of  the 
various  measures.  These  are  notetl  es])eciallv  in  the  death  rate  from  this 
disease  in  Chicago,  where  the  effects  are  more  striking  because  the  measures 
were  effective  in  the  whole  ;irea,  while  in  ihr  St.ite,  they  were  ailopted  at 
various  times  in  ditf'erent  localities. 

.\nti-lyplioi<l  inoculation  was  ad\dc;ili-d  b\  the  Secretar\'  of  the  State 
Board  of  Health  in  liMl  and  the  columns  of  the  Biillctiii  were  devoted  to 
ex])lainin,g  its  merits. 


34-1  III;. \i. Ill  foxiii  iinxs  aI'Ti:k  ISTT 

AiiiiiluT  iiux-sliyaliciii  wiiicli  rrllci'Icd  crc-ilit  u])iin  tlic  l'>n;iril  aiul  its 
orgnnizalidii  was  llial  of  the  I'.M:!  lyplmid  t\-vrr  c'|ii(leiiii(.-  al  Kockl'dni. 
When  ill  tlu'  jii\-\iiui>  \rar,  huiuhcck  of  cases  (if  tlie  (hsease  sU'ldeiily  ilc- 
velopcd  ill  liial  eit\-,  an  in\-esli.i;aliiin  iiide]ieiident  (if  tlie  StaU'  Pjnard  (if 
Heahh  was  made  h\'  ihe  eil\-  aiulKirilies  aided  hy  outside  experts,  and  at  an 
expense  of  several  thousand  dollars.  Impure  water  was  assi^jned  as  the 
cause  of  the  outhreak.  When,  however,  in  the  late  summer  of  11)13  another 
epidemic  of  txiihoid  threatened,  the  service  of  the  Board  was  requested  for 
the  purpose  of  detennininsj  the  cause  of  its  recurrence.  Almost  all  the 
cases  were  traced  t(j  milk  and  hread  from  dairies  and  bakeries  in  which 
cases  of  typhoid  fever  had  existed.  The  sale  of  milk  and  hread  from 
these  dairies  and  bakeries  was  st(i]iped  and  the  epidemic  ceased. 

F.xperiences  of  this  kind  attracted  attention  to  milk  su]i]ilies.  This 
mitjht  have  been  anticipated.  As  water  supplies  came  to  be  more  and  more 
sanitary  tliere  remained  considerable  typhoid  fever  and  investig-ators  lie.gan 
to  look  for  other  media  of  transmission.  Milk  was  next  to  water  in  im- 
portance so  that  it  was  logically  the  next  in  line  to  be  sanitated.  From  li)15 
onward  a  considerable  number  of  typhoi(l  fever  outbreaks  were  traced  to 
milk  on  the  one  hand  while  the  sanitary  ([uality  of  municipal  milk  supplies 
improved  through  the  increasing  use  of  ])asteuri/-atioii  on  the  other. 

.\fter  1;M."i  reliiieiiient  in  control  lechni(|Ue  was  the  dominating  feature 
in  efforts  directed  toward  the  eradication  of  typhoid  fever.  Free  distribu- 
ti(Mi  of  anti-tviihoid  vaccine  was  started  in  r.il4  but  it  was  after  the  World 
\\"ar.  during  which  emergency  the  efficacy  of  this  pro])hylactic  was  adniir- 
ablv  demonstrated  li\'  the  military,  before  it  was  used  to  any  significant  ex- 
lent.  Its  use  was  promoted  successfully  after  that  time  and  it  was  generally 
appreciated  and  utilized  subsequent  to  emergencies  like  the  devastating  tor- 
nado that  swept  southern  Illinois  in  l!i-.'."i  and  the  many  floods  that  inundated 
considerable  populated  areas  almost  annually. 

An  emergency  sterilizing  ontlit  serviceable  for  temporary  use  in  con- 
nection with  local  public  water  supplies  was  made  available  by  the  State 
Department  of  rublic  Health  in   I'.M;.      It  was  used  from  time  to  time. 

.\  field  lal)orator\-  outlit  serviceable  for  the  examination  of  sjiecimens 
helpful  in  the  diagnosis  of  cases  and  in  the  location  of  carriers  was  made 
a\-ailable  about  this  time. 

About  r.i'.'l  tw(i  other  iin|iortaiit  rehnemeiits  took  jilace.  One  was  a 
deterniiin-d  campaign  to  locate  and  su]iervise  carriers,  'flu"  other  was  a 
revision  in  tlu-  i|uarantine  rules  which  among  other  things  re(iuired  negative 
lab(irator\-  examinations  of  specimens  i.aken  from  typhoid  patients  before 
raising  (|uarantine.  'i'he  ]irosecutioii  of  these  ]irocedures  had  a  very  pro- 
nounced fa\(irable  intluence  over  the  trend  of  ty|ihoi(l  prevalence  in  Illinois. 


HEALTH    CONDITIONS   AFTER    1S7T 


345 


The  two  following  tables  include  most  of  the  important  outbreaks  that 
occurred  during  the  period  covered.  It  is  noteworthy  to  observe  that  the 
number  of  cases  involved  in  epidemics  grows  smaller  as  the  date  become? 
more  recent. 


Some  Water-Borne 

Typhoid  Fever 

Epidemics  in  Illinois. 

Count}-. 

Locality. 

Year. 

Monlhs. 

Cases. 

Deaths. 

Remarks. 

Winnebago 

Menard 

1912 
1915 
1916 

1916 
1918 

1920 

1920 

1922 
1923 

1924 
1925 

1923 

1925 
1925 

Jan.-Feli - 

185 
200 
200 

130 
125 

300 

10 
200 

12 
3,000 

13* 
14 

15 
20 
20 

? 
24 

24 

3 

20 

2 

3* 

3 

Old  Salem 

.Si'iit.-Oct 

Aug:ust 

|.uM„     -uirl-     «ell. 

Kl Iiiiu    ni    i.iililic    water    sup- 

pl\    utllt,  ami  no  sterilization. 

Tuscola 

Moline 

Maywood 

Bloomington-... 

tion   in    Elgin    Watch   Factory 
between     safe      and     polluted 
supplies. 

Rock  Island 

Pumping     of     raw     river    water 

through    a   bypass. 
Spvop.    .li^fntrrv    ,\w    tn    leaky 

October 

Jan.-Feb 

Apr.-May 

I.,.:,;   X       ,   ,,,---,  M.Hir.   M..ri      l.t-tWCeU 

ii,.lii-ln;il       Mi].|.l\       .ni,l       the 
ilvnikinu    water    supply. 
K'lood     of     wells     duruig     high 

Chicago 

Sterliif^r _. 

(ireenville    

Winona  (Ind.).. 

water. 
K.\cessive   pollution   at   the   68th 

Whiteside 

Bond 

Dec.-Ja.i 

January 

.June 

.St.  pumping  stations  minus 
a  sufficient  increase  in  chlori- 
nation. 

Leaky  valve  in  factory  cross- 
connection  between  safe  and 
polluted    water    supiilies. 

Severe  dysentery  and  para- 
typhoid due  to  tile  water 
ii;,ni[    .i)i-i.iMiiu    sewage    from 

Spii  (.1     ml..    '  ii:lit    states    from 

AUK.-Sept 

liiijliiii.l   \v:ii.-i    supply  used  by 
ciuivention    delegates". 
Polluted   public   water   supply. 

s    cases    and    deaths. 

Outbreaks  of  AIilk-Borne  Typhoid  Fever  in  Illinois. 


Locality. 


Year. 


Months 


Winnebago... 

Cook 

Macon 

DuPage 

Rock  Island.. 

Morgan 

Douglas 

Madison 

Coles 

Hancock 

Carroll 

Macon 

Kane 

Bond 

Morgan 

Bond 

Henry..- 

Douglas 

Montgomery. 


Rockford 

Park  Ridge.. 

Decatur 

Wheaton 

Molii 


Jacks 


Decatur 

Compto 

Twp. 


ille 


St.   Charles 


19111 
1920 
1919 
1920 
1920 
1921 
1921 


M,i 


Aug.,  Sept.. 
Sept.-Oct.... 
June,  July.. 
Jul,v,  ,\ug... 
December... 
June,  July.. 

.Uignst 


Bottle 
Polluted   w 
Milk  bottle 


Iter   at   dairy 


Convalescent 

Carrier 

Carrier 


34G 


iii:altii  co.mhtions  aftkk  li-i" 


As  water  and  milk  supplit's  in  recent  \'ears  became  inure  and  more  gen- 
erally of  good  sanitary  (|naiity  (itlier  faclois  in  the  s]jread  of  typhoid  fever 
began  to  lake  ])r(iminence. 

'I'iuis  in  lli'.'i  an  unllireals.  contined  principally  to  Chicago  and  environs, 
was  traced  Id  the  eating  ni  raw  nysters.  This  discovery  uUimatelv  led  to 
drastic  actinn  in  relation  to  shell  lish.  The  State  Director  of  Public  Health 
issued  an  order  in  the  early  part  of  I  If.'"),  fin-bidding  the  sale  of  oysters  for 
any  except  cooking  purposes.  This  action  in  turn  resulted  in  a  general  sani- 
tary reform  of  the  oyster  industry,  referred  to  elsewhere  in  this  volume. 

Little  of  significant  importance  concerning  typhoid  fever  in  Illinois  has 
tran.spired  since  the  sanitary  reform  of  the  oyster  industry.  Automobiles 
have  become  a  larger  and  larger  factor  in  the  spread  of  the  disease.  This 
was  demonstrated  in  liJSo  when  touring  parties  brought  typhoid  back  from 
an  Indiana  town  and  caused  mild  outbreaks  at  Freeport  and  Polo.  It  is  also 
indicated  by  the  fact  that  foci  of  the  disease  are  more  and  more  widely  dis- 
tributed and  a  growing  diminution  in  the  average  number  of  cases  involved 
in  any  one  epidemic. 

With  increased  facilities  for  managing  the  disease  mortalit}'  has  tended 
downward  although  it  has  fluctuated  from  year  to  _\ear  as  it  always  will  so 
long  as  typhoid  remains  upon  the  earth. 

Indeed  severe  outbreaks  will  occur  from  time  to  time  where  preventive 
sanitary  precautions  are  neglected  lor  any  reason.  This  was  demonstrated 
in  1037  when  Montreal,  Canada,  experienced  one  of  the  worst  epidemics 
ever  rejiorted  on  the  North  .\merican  continent.  It  involved  more  than 
5,1)00  cases  and  nealv  30(1  deaths  and  extended  over  a  period  of  more  than 
six  months. 

In  Illinois  the  mortality  and  sickness  from  typhoid  fever  in  lUiii  was 
the  most  favorable  ever  recorded.     Only  330  deaths  were  reported. 

The  favorable  record  in  1930  was  sim])ly  another  step  forward  in  the 
improvement  that  has  been  going  on  fairly  constantly  since  the  opening  of 
the  century.  As  ultimate  extinction  of  the  disease  approaches,  the  degree 
of  annual  decline  grows  smaller,  but  no  less  significant  and  valuable.  Since 
l!Ms  the  decline  in  the  mortalit}-  rate  has  amounted  to  slightlv  more  than  tSO 
jier  cent. 

MORT/\LITY  FROM   Tvi'IIOID  FeVER  IN   ILLINOIS. 


Ye:ir. 

!9I8. 

1919. 

1920. 

1921. 

1922. 

1923. 

1924. 

1925. 

1926. 

Number  l>«iths 

Rate  per  100  000 

519 
8.2 

383 
5.9 

380 
5.8 

396 
5.8 

282 
4.0 

317 
4.7 

239 
3.5 

327 
4.7 

230 
3  2 

The  fly  in  the  ointment  of  the  splendid  1936  experience  is  the  bad  record 
of  the  3-1  counties  which  make  up  the  extreme  southern  tlJrd  of  the  State. 


HEALTH   COXniTlOKS   AFTKK    IS,  , 


347 


These  3-1  couiitifs.  with  Ixit  httle  mure  than  one  iiiilHon  people,  lost  116  in- 
habitants to  typhoid  fe\er,  whereas  the  uther  68  counties  with  a  population 
of  fully  six  million,  lost  nnly  111.  There  is  some  evidence  that  warm  cli- 
matic conditions    favor  the   projiagation   of   tyi)hoid.        The    fact   that   mild 


weather  prevails  much  longer  in  southern  than   in  northern    Illinois  ma\-  he 
a  factor  in  the  unfavciralile  typhoid  rate  in  the  sdutheni  section. 

The  rate  per  lOd.OiMl  was  only  1.:)  in  the  -'i:!  cuunties  that  make  up  the 
extreme  northern  third  (if  the  State.  Here  nearly  five  million  ])eople  are 
concentrated. 


3-1-S  III-.. \l. Ill    C'O.NDITIONS  AFTEK   1ST7 

In  tlio  central  ihird.  the  rau-  was  ".'i.  A  little  less  than  one  and  one 
(|iiarler  million  people  dwell  in  the  .'io  counties  here  concerned. 

rile  \rr\-  faxorahle  record  in  Cook  County  influenced  the  good  showing 
in  the  north.  In  that  ci  niU\-  where  the  estiniate<l  population  is  3,-186,600, 
tlu-re  were  oiiK'  ''*'>  di.-aths  recorded  I'rcjni  l}-])hoid.  That  gives  a  rate  of  0.7. 
'The  rate  for  the  other  :>■,'  northern  countie.-^  was  'i.].  considerahly  more 
fav(n-ahle  than  either  the  cenlral  or  southern  sections. 

There  were  ■.'0  cities  of  10,0(10  (ir  more  population,  and  '']  counties 
from  which  no  deaths  at  all  from  typhoid  fever  were  reported.  Indeed  the 
inortalitv  was  confined  largely  to  the  small  communities  aitd  rural  areas. 

Tliese  data  jioint  directlv  to  the  wholesome  influence  of  public  health 
activities.  Typhoid  fever  death  rates  ilecline  as  volume  of  jiublic  health  serv- 
ice increases. 

Scarlet  Fever. 

When  the  State  Board  of  Ilealth  came  into  existence  in  ISTT,  Chicago 
was  passing  through  the  greatest  epiilemic  of  scarlet  fever  in  its  history.  The 
<leath  rate  from  the  disease  in  that  citv  was  1 '.)(),.")  per  IdO.OOo  j.ioptilation  that 
year. 

Doubtless  the  disease  also  spread  into  the  neighl.».jring  territory  and  was 
more  or  less  iirevalent  throughout  the  State,  yet  this  situation  received 
practicallv  no  attention  from  the  Koard.  The  reason  for  this  is  not  difficult 
to  apprehend  if  the  problems  and  resources  of  the  Board  at  that  time  are 
considered.  Furthermore  there  is  the  fact  that  no  special  precautions  were 
taken  against  the  disease  by  health  authorities  in  the  seventies. 

Even  in  a  city  the  size  of  Chicago,  which  had  a  population  of  about 
.'jiKi.ooii.  the  reporting  and  placarding  of  scarlet  fe\er  cases  was  not  enforced 
until  is::,  and  then  it  brought  forth  violent  protests  from  the  people.  Phy- 
sicians referred  to  it  as  the  "Yellow  Card  Nuisance." 

In  is.so.  a  census  vear,  1,364  deaths  from  scarlet  fever  were  reported 
fur  the  State,  which  is  a  rate  of  a  little  over  44  per  100,(10(1  population. 
X'ever  since  that  year  has  the  reported  mortality  rate  exceeded  3'2  per  100.000. 

The  course  of  scarlet  fever  from  1860  to  date,  is  showni  in  Figure  21,  by 
the  decennial  and  annual  records,  as  far  as  these  are  available. 

4'his  chart  shows  that  mortality  from  scarlet  fever  declined  ra])idly 
afur  (he  hit;  epidemics  of  is;;  and  ISSO.  4"he  reason  appears  to  be  found 
in  the  .iciixiiies  of  health  officers.  Xo  noteworthy  advancement  was  made 
prior  to  \'.i\:>  in  meilical  knowledge  concerning  scarlet  fever.  A  great  deal 
was  undertaken  bv  the  public  health  .-i^eiicies.  however,  and  ])articularly  in 
Chicago   where   the   best   local    organi/alion    in    ihe    State   was   at    work. 


HEALTH   COXDITIOXS   AFTKR    1  S  1  "i 


349 


The  control  measures  einpU)yed  included  public  etlucation,  the  retiuire- 
ment  of  case  reports,  the  isolation  of  patients  and  the  quarantine  of  premises, 
the  medical  inspection  of  school  children  and,  to  a  less  extent,  the  hospitaliza- 
tion of  jiatients.  None  of  these  things  developed  uniformallv  in  the  State 
nor  were  all  of  them  begun  simultaneously.  The  educational  propaganda 
started  first,  about  1880,  when  the  .'-^tate  Board  ])ublished  and  distributed 
literature  freely.  The  Board  also  made  the  disease  reportable  but  few  notifi- 
cations were  received  except  in  Chicago  where  local  ordinances  were  em- 
ployed. 


9ol 

Mji'l'MM!!    1 

Tl'i  11  Ili^^TII  TTIT 

1    1   1       M       1 

"1 1  ■     ■ "" ' 

» 

lyjiJ^d-Lii-l^i^ 

,    ,                     ' 

I 1    1  ■  '  1  °^ 

fT^!  ,'    !  '-Ttl- 

iMtbCAKL"  1     r  LVLk: 

-  ~  -Lii-4-^-^ 

^"    IPi 

ILLIhOIS"-^- 

1 1     I        1 

■w 

"  ^-rt 

:  ,!    :  :'  1 

louw   I7CD           :: 

1        _;_             li^^^b"ATIbTIC5    UnWAILAtSLL    hOW  OCtn    YLAK5  . 

: !  ;  i '  1     1 

ir_  _    _:  1  :::.±_t 

r_  ^    __T ,__ 

F  -^ 

'    !  1      1      ll 

if-  W-— +4^ 

< 

^  ^— — — ■  —  — ^— --— -'-rrr 

1 '   '  < 

o  ■" 

+        ITi-^-    --T 

d 

1-^  ,  1                                     't   "          ^ 

fY    20 

_r 

Q. 

1         '1        l' 

S  " 

J  ' '  •  1 

i  1 1 :  i  1 

l-r 

1  i 

^  i  f  iiC 

Ui. 

'        M 

N   -1 

^^^m 

1            i 

^^^^H    f              1       1       r 

II     ^^^^^^^^^^^H  i  1 1 !  1    1 

Shortly  before  liJOO  it  became  the  practice  of  the  Slate  Board  of  Health 
to  send  medical  inspectors  to  epidemic  foci.  These  men  promoted  isolation 
of  patients  as  their  chief  control  measure  and  this  appears  to  have  been  ac- 
companied by  favorable  results  in  reference  to  the  spread  of  the  disease. 
Scores  of  communities  suffered  from  outbreaks  during  the  first  decade  of 
the  twentieth  century  so  that  the  reports  of  the  State  Board  are  filled  with 
accounts  of  investigations  and  resultant  control  measures,  usually  in  the 
form  of  i|uarantine. 


3:)ii 


lir.AI.rii    tDNDITIONS   AFTF.H    IS" 


Another  very  impurtaiit  factor  in  controlling  scarlet  fever  began  to 
assume  importance  about  lims.  This  was  the  iiromotion  of  milk  pasteuriza- 
tion. Dining  the  previous  year  Chicago  went  through  a  serious  epidemic 
of  scarlet  fe\er  and  evidence  gathered  by  the  epidemiological  investigators 
indicat^■d  tile  milk  sup])ly  as  the  means  through  which  the  disease  was  spread. 


2Z0O 

-   SCARLET     FEVER     CASE     REPORTS     Ih    ILLlhOIS 

2000 

_                                                                                LEIGEHD 

"^---..^^                 7    Year    Adjusted    Median    1919-1923  — o^^^^^o-" 

\^             1924-    Cose      Reports                            —o—^.-O-—      ^ 

1600 

—                  \ 

1400 

--...    m. 

1200 

1000 

800 

Va.      ~~q                                      /' 

X-    '^                    /'' 

600 

\,  '\^               Jl 

400 

\\,^/>' 

200 

1           1            1           1           1           1 1 

Jan.      Feb      Mar     Apr      May    June     July      Auq      5ep       Oct.      Nov      Dec. 

Pic.  22.      Note  tlie  sliarp  upward  swing  of  the  1924  line  for  December. 

Table  :'.]. 


C.ASES  OF  Scarlet  Fever 

Reported 

BY  Months  in 

Illinois. 

Vfur. 

.liin. 

Feb. 

Mar. 

.\pr.    1   May. 
1 

June. 

JU1.V. 

Aug. 

Sept. 

Oct. 

Nov.      Dec. 

Total. 

1916 

1,878 

1,891 

2,281 

1,564 

1,547 

893 

416 

239 

488 

933 

1,264  1  1,682 

15,076 

1917 

2,284 

2,625 

3,403 

2,488 

2,230 

1,329 

699 

351 

528 

401 

232  j      648 

17,220 

1918 

758 

611 

561 

505 

362 

148 

150 

101 

231 

189 

2C1  i     ros 

4,025 

1919 

440 

588 

662 

586 

495 

289 

99 

97 

304 

656 

893  1  1,101 

6,210 

1920 

2,449 

2,235 

2,335 

1,708 

1,456 

862 

429 

293 

715 

1,385 

1,972 

2,637 

18,476 

1921 

3,116 

2,525 

2,241 

2,113 

1,629 

710 

330 

412 

857 

1,569 

1,77S 

1,743 

19,023 

1922 

1,967 

1,817 

1,388 

936 

671 

465 

240 

370 

526 

1,143 

1,419 

1,314 

12,256 

1923 

1,556 

1,071 

1,066 

816 

739 

475 

241 

227 

444 

768 

1,008 

1,123 

9,474 

1924 

1,435 

1,317 

1,508 

1,148 

1,003 

780 

383 

208 

396 

891 

1,105 

1,516 

11,690 

1925 

2,064 

2,103 

2,384 

1,772 

1,682 

909 

351 

261 

377 

755 

1,279 

1,755 

15,692 

1926 

1,847 

2,129 

2,051 

1,507 

1,397 

947 

488 

297 

376 

816 

1,124 

1,265 

14,244 

This  disclosure  led  the  health  commissioner  of  Chicago  to  require  the  pas- 
teurization of  milk  supplies  ottered  for  sale  in  that  city.  The  order  became 
effective  in  linis  but  it  was  r.)l.'i  bi'fore  f;icilities  were  available  to  make 
the  entire  su|iply  of  the  city  coniplcteU  p;isteurized  except  two  percent  which 
was  certitied. 


HEALTH    COXDITIOXS   AFTER    187' 


351 


Observation  of  the  inijjrovenieiit  brought  about  in  Chicago  as  an  ap- 
parent result  of  pasteurization  led  to  the  gradual  extension  of  this  procedure 
throughout  the  State.  It  was  ])ronioted  with  vigor  by  the  State  Depart- 
ment of  I'ubHc  Health  subsequent  to  ID'-il,  a  fact  referred  to  elsewhere  in 
this  volume. 

The  medical  insijection  of  school  children  doubtless  was  an  important 
factor  in  controlling  scarlet  fever  and  other  diseases  as  well.     It  has  never 

Table  -.Vi. 
Deaths  FROii  Scarlet  Fen'er  ix  Illixois  by  AIoxths. 


Year. 

Jan. 

Feb. 

Mar. 

Apr. 

Ma.v. 

June. 

Jul.v. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

Total. 

1918 

28 

17 

22 

23 

11 

8 

5 

4 

2 

10 

13 

6 

149 

1919 

19 

27 

29 

23 

18 

13 

6 

6 

4 

18 

29 

33 

225 

1920 

50 

53 

55 

29 

33 

22 

8 

4 

13 

24 

41 

30 

370 

1921 

45 

49 

51 

47 

34 

32 

11 

12 

17 

30 

38 

47 

413 

1922 

57 

48 

37 

31 

16 

13 

7 

15 

9 

18 

21 

30 

305 

1923 

36 

28 

42 

15 

23 

13 

7 

7 

10 

11 

10 

27 

229 

1924 

27 

27 

25 

27 

18 

10 

8 

4 

6 

9 

15 

30 

206 

1925 

34 

28 

59 

34 

32 

11 

6 

9. 

5 

10 

20 

20 

268 

1926 

34 

23 

38 

31 

26 

21 

10 

10 

6 

11 

14 

9 

233 

Table  33. 
Deaths  and  Death  R.\tes  from  Scarlet  Fever  in  Illinois. 


Rate  per 
100,000 
No.  deaths.       population. 


Rate  per 

100.000 

No 

.  deaths. 

population. 

516 

9.2 

575 

10.1 

608 

10.5 

694 

11.9 

1,022 

17.2 

1860  

1,698 

1870 

2,162 

1880 

1.369 

1881 

856 

1882 

687 

1883 

1,048 

1884 

832 

1885 

802 

1886 

743 

1890 

442 

1900 

643 

1902 

735 

1903 

519 

1904 

368 

1905 

177 

1906 

602 

1907 

S8() 

1908  

533 

83.1 

1910 

44.4 

1911 

27.1 

1912 

21.2 

1913 

31.7 

1914 

24.6 

1915 

23.2 

1916 

21. 

1917 

11.5 

1918 

IS. 3 

1919 

14.7 

1920 

10.2 

1921 

7.1 

1922 

3.3 

1923 

11.3 

1924 

16.3 

1925 

been  practiced  with  a  large  degree  of  systematic  regularity  except  in  Chicago 
but  infiuc-nce  on  communicable  diseases  there  always  has  a  pronounced  effect 
on  the  iirexaleiice  rates  in  the  State.  Manv  other  places  enijiloyed  |)ublic 
health  nurses  for  work  in  the  schools,  especially  after  the  \\'orld  War.  and 
tlu-ir  work  ])roduced  marked  improvement  in  the  communicable  disease  in- 
cidence in  the  communities  which  they  served. 


3.V2  inc. \i. Til  coxDrno.Ns  ai-ti;k  ]8TT 

The  year  of  \'W,  marks  the  heginnint;-  of  the  jicrioil  when  statistics 
of  a  rcHable  character  became  available  fur  the  State  i^enerall)'.  In  that 
year  means  for  securing  fairlv  complete  rejjorts  of  cases  of  scarlet  fever, 
along  with  otln-r  diseases,  were  employed.  This  enabled  State  health  oili- 
cials  to  keep  informed  about  the  situation  at  all  times  and  to  be  in  a  j)osition 
to  exercise  control  measures. 

The  most  important  step  forward  toward  the  control  and  ultimate  elim- 
ination of  scarlet  fever  came  from  bacteriological  research  in  1921.  It  is  of 
especial  interest  here  because  two  Illinois  physicians,  (ieorge  F.  and  (Gladys 
H.  Dick,  working  together  in  the  McCormick  research  laboratories  in  Chi- 
cago, discovered  that  a  certain  strain  of  streptococcus  is  responsible  for  scar- 
let fever  and  that  toxin  from  these  organisms  may  be  used  to  determine 
through  skin  tests  susceptibility  to  the  disease.  Prophylactic  and  therapeutic 
agents  were  also  developed  from  the  toxins. 

The  fundamental  scientific  facts  in  regard  to  the  etiology  of  scarlet 
fever  had  been  known  for  some  time.  The  first  was  that  some  one  or  more 
of  the  streptococci  were  concerned  in  its  symptomatology.  As  to  the  causa- 
tive relations  of  the  streptococcus  there  were  two  schools.  One  held  that 
the  streptococcus  was  the  cause  of  the  disease.  The  other  held  that  strep- 
tococci were  so  nearly  ubiquitous  and  caused  so  many  diseases  that  they 
could  not  be  the  specific  cause  of  scarlet  fever.  This  school  held  that  the 
specific  cause  was  some  unknown  organism,  but  that  the  streptococci  con- 
tributed materially  to  the  symptoms.  The  theory  upheld  by  Bristol  that  the 
rash  of  scarlet  fe\er  was  an  anaphylactic  phenomenon  for  which  streptococci 
was  the  bacterial  cause,  lent  more  su|ii)ort  to  this  side  of  the  (luestion  than 
it  did  to  ethers. 

Dr.  A.  R.  Dochez,  by  the  use  of  certain  culture  methods,  demonstrated 
the  one  variety  of  streptococcus  which  he  claimed  could  i)roduce  the  disease, 
and  in  that  wav  seemed  to  establish  tlit'  priniac\-  of  tlie  stre])tococcus  as  the 
ctiologic  agent  and,  at  the  same  time,  to  answer  the  i)(jint  made  by  Jochmann 
that  an  organism  which  was  so  witle-spread  and  caused  so  many  diseases 
eonlil  not  Ije  the  s]iecitic  cause  of  scarlet  fe\er. 

It  reniained  for  the  Dicks  in  l'.)"?1  to  jirove  experimentally  that  a  certain 
strain  of  streptococcus  grown  from  throats  of  persons  having  scarlet  fever, 
when  injected  into  suscejitible  human  beings,  produced  the  disease.  The 
Dicks  extracted  a  toxin  from  this  streptococcus  which  is  now  being  used 
to  make  a  skin  test  for  determining  the  susceptibilit\-  of  persons  to  scarlet 
fever.  This  ])r()cednre.  called  tin'  Dick  ti'st.  is  done  the  same  as  the  Schick 
test  in  reference  to  diphtheria.  .\  toxin  for  ]ireventing  scarlet  fe\er  has 
also  been  developed.      It  is  given   in  mnch  the   same  wav  as  to.xin-antitoxin 


HEALTH   COXDITIOXS   AFTER    18T7  SoS 

for  the  prexcntion  of  diphtheria.  Not  only  that  but  there  is  now  availal)le 
an  antitoxin  for  the  curative  treatment  of  scarlet  fever. 

The  outlook  for  ridding  the  country  of  scarlet  fever  is  therefore  promis- 
ing. 

The  greatest  prevalence  of  scarlet  fever  is  almost  always  experienced 
in  mid-winter,  usually  in  January  or  early  February.  Greatest  freedom 
from  it  is  enjoyed  in  August.  The  disease  runs  almost  as  true  to  this 
course  as  vegetation  does  to  the  seasonal  changes  which  govern  floral  life. 

For  some  reasin  which  is  not  altogether  clear,  scarlet  fever  lost  a 
good  deal  of  its  \irulency  during  the  second  and  third  decades  of  the  twen- 
tieth century.  In  lil2G,  for  instance,  there  were  14,24-1:  cases  reported  with 
only  233  deaths  whereas  19,825  cases  in  191T  left  TUl  dead.  Fatalities 
mounting  to  l.uOO  or  more  per  year  were  evidently  common  in  Illinois  prior 
to  liliiO  but  it  seems  im])robable  that  the  number  of  cases  was  correspond- 
ingly large. 

The  trend  of  the  disease  both  as  a  cause  of  death  and  sickness  ma\-  be 
observed  from  tables  31,  32  and  33.  Its  seasonal  beha\ior  is  illustrated  in 
Figure  22.  A  graphical  illu.stration  of  the  mortality  record  from  scarlet 
fever  is  given  in  Figure  21. 

Diphtheria. 

The  State  Board  of  Health,  in  the  years  immediateh-  after  its  organiza- 
tion in  187T,  was  especially  concerned  with  the  regulation  of  the  practice  of 
medicine,  and  the  suppression  of  epidemics  of  yellow  fever,  cholera  and 
smallpox.  The  other  contagious  diseases,  including  diphtheria,  which  were 
then  attributed  to  filth  and  bad  sanitation,  \yere  left  largely  under  the  con- 
trol of  local  health  organizations  or  practicing  physicians. 

There  are  no  statistics  available  showing  the  prevalence  of  diphtheria 
or  the  death  rate  from  the  disease  in  Illinois  for  the  years  18T7,  18';8  and 
18:!). 

In  l.^sl).  the  United  States  cen>us  >h(iws  thai  in  Illinois,  with  a  jjupula- 
tion  of  a  little  oyer  three  million,  there  were  M,7s:;  deaths  from  diphtheria, 
or  123  for  each  100,000  inhabitants.  Chicago,  too,  in  this  \ear  recorded  a 
rate  of  2!)0  per  100,000  jxipulatiim,  the  highest  d:j)htheria  death  rate  ever 
recorded  for  the  city.  The  diphtheria  death  rate  continued  high  in  1881, 
18S2  and  18,s;i. 

In  18S3  the  State  Hoard  of  llcalih  (li>trihuted  an  educational  circular 
on  the  prevention  anil  control  of  diphtheria  from  which  the  following  para- 
graph is  quoted : 

"Diphtheria  I'as  so  often  appeared  where  uncleanly  conditions  have  prevailed, 
when  it  could  not  be  traced  to  continuous  propagation  b.v  contagion  that  its  rela- 
t'.n  to  tilth  a?  a  cause  may  he  assumed  for  sanitary  purposes.     It  is  immaterial 


3:.  4 


mCAl.TIl   CONDITIONS  AFTKR    1877 


whether  this  tilth  exists  in  visible  and  disgusting  form  such  as  the  garbage  heap, 
the  cess-pool  or  the  privy  vault  or  in  the  invisible  and  possibly  inodorous  gases 
from  an  illy  constructed  sewer;  from  decaying  vegetables  in  the  cellar  or  in  the 
poisonous  exhalations  from  the  human  breath  and  body  in  unventilated  rooms.  All 
these  undoubted  causes  of  ill  health  should  be  at  once  abated." 

Tlii.s  .same  circular  also  stated  that  diphtheria  frequently  caused  mure 
deaths'  than  tyi)hoid  fever,  smallpox,  scarlet  fever,  and  measles  combined. 
During  the  first  10  years  of  the  State  Board  of  Health,  from  1877  to  188(), 
Chicago  anmially  averaged  i(i8  deaths  fn>m  diphtheria  for  each  loii.ooo  of 
population. 

Diphtheria  was  indeed  a  terrible  disease,  and  today  it  can  readily  he  ap- 
preciated how  fuiile  were  the  efforts,  made  at  great  expense,  in  trying  to 
combat  its  sjjread  b\-  re-laying  sewer  pipes  and  drains,  on  the  theory  that  it 
was  a  filth  disease. 

In  1887  the  health  department  of  the  city  of  Chicago  declared  that  di]ih- 
theria  wa--  not  a  filth  hut  a  contagious  disease  like  smallpox. 


Table  U. 
Dii'iiTin:Ri.\  Including  Croup,  Chkaco  Cases  and  Deaths,  ]89:i-lS99. 


1897  . 

1898  . 
1899 


Keporterl. 


1,4S1 
1,406 
1,632 
1,098 


Another  step  away  from  the  filth  theory  took  place  in  18!)]  when  the 
State  Board  of  Health  ordered  that  bodies  dead  from  diphtheria  could  no 
longer  be  transported  by  common  carriers  because  of  danger  of  sjireading 
the  disease. 

In  Chicago,  diiihtheria  was  made  a  reportable  contagious  disease  in  18!)2 
Init  this  order  was  not  comjilied  with  very  extensively  because  neither  the 
medical  ]n-ofession  nor  the  public  was  ready  to  accept  the  germ  theory.  Table 
;!l,  compileil  from  the  annual  reports  of  the  health  deiiartnient.  shows  how 
far  shiut  the  (  tTori  lo  collect  morbidity  reports  fell. 

.Meinl)rani'iis  croup  \\;is  m.ade  reportable  in  1898.  ' 

The  filth  ilieorv  of  the  origin  of  diphtheria  gave  way  completely  before 
bacteriological  research  >o  th;il  by  is'.i.'i  the  whole  problem  of  prevention  was 
regarded  by  forward  looking  sanitarian>  m  a  new  light.  In  that  year  anti- 
toxin as  a  sjiecihc  cur.ative  agent  was  introduced.  On  September  iMh,  Chi- 
cago opened  (>0  stations  at  convenient  points  in  the  cit)-  from  which  this  new 
product  could  be  bought  at  reasonalile  prices  and  had   free  by   the  pocir. 


HEALTH   COXDITIOXS  AFTER    ISTT 


355 


Althini.t,'h  Uiere  wcrt-  nianv  cases  cif  diphtheria  and  many  deaths,  and 
talk  (if  clcising  simie  nf  the  pnlihc  schiidls  because  of  e])idemic  conthitions, 
yet  not  a  single  vial  of  the  serum  was  called  for  at  any  station  until  October 
5,  ISII.').  This  was  true  in  spite  of  wide  publicity  given  through  the  public 
press  and  illustrates  the  skeptical  attitude  of  physicians  toward  the  new  treat- 
ment for  diphtheria. 

Because  physicians  were  slow  to  use  the  new  remedy,  and  especially  be- 
catise  of  the  many  deaths,  the  health  department  used  all  available  mem- 
bers of  its  medical  staflf  in  administering  antitoxin,  and  in  teaching  the  medi- 
cal profession  the  methods  of  using  it.  This  practice  soon  made  necessary 
36  additional  supply  stations  while  434  drug  stores  were  authorized  to  act 
as  agents  for  the  distribution  of  diphtheria  culture  outfits. 

Between  October  5,  1895,  and  April  1,  189(i,  there  were  l.liis  true  cases 
f bacteriologically  verified)  of  diphtheria  treated  with  antitoxin  of  which 
number  1.3T4  recovered  and  94  died,  a  fatality  of  U.  1  ])er  cent. 

An  analysis  of  805  of  the  true  cases  referred  to  aljuve  shows: 


Treateil  on. 

Total. 

Recovered. 

Died. 

Death  rate. 
(Per  cent) 

1st  day - - 

61 

187 
372 
1C9 
76 

61 

0 

0.00 

3rd  (ia.v 

4th  da.v 

Over  4  days.                                             

3e2                           10 
02                           17 
54                           22 

2.6S 
1.5.60 
2S.91 

803 

753                             52 

6.46 

By  Xdveniber.  is:)."),  antitoxin  administrations  were  being  used  to  such 
an  extent  that  it  was  s|)iiken  of  as  (jcucrallx  adopted. 

The  use  of  antitoxin  as  a  preventive  of  di])htheria  in  Illiniii>  began  dur- 
ing the  autumn  of  ISIl").  It  was  argued  that  a  drug  which  could  cause  so 
prompt  and  complete  recovery  from  diphtheria  ought  to  be  heliiful  in  its 
prevention.  This  proved  to  be  the  case  so  that  the  practice  of  injecting  anti- 
toxin into  susceptible  persons  exposed  to  di]ihtheria  expanded  coextensively 
with  the  use  of  this  ]iroduct  as  a  curative. 

Collecting  Case  Bcjiart.s  a  Pnihlctii. 

Once  started  the  use  of  antitoxin  became  rouline  practice  and  caused 
far  less  trouble  for  health  officers  than  the  matter  of  case  reports.  In  the 
State  at  large  very  little  pressure  was  brought  upon  the  local  doctor  to  get 
reports  because  there  were  no  local  health  organizations  of  conseqiience  but 
in  Chicago  first  one  expediency  and  then  another  was  em])loyed  to  promote 
reporting.  The  medical  profession  was  more  or  less  recalcitrant  on  the 
whole  so  that  Chicago  was  one  of  the  last  of  the  large  cities  in  the  countrv 
to  reach  the  point  where  diphtheria  quarantine  was  handled  in  an  efficient 


356 


HEALTH   COXniTIONS  AFTER   18TT 


way  from  a  pulilic  lu-allh  staiKl])<}iiit.  Table  '■'>')  indicates  hy  the  relatively 
small  (liffereiice  lietween  case  and  death  re])(irls  that  ndtilication  was  li_\-  no 
means  com])lele  during  the  period. 

After  llHi;  im])rovement  in  case  reports  began  to  \iv  noticeable  tirst  in 
Chicago  and  later  throughout  the  State.  This  was  stimulated  by  the  activity 
of  health  officers,  local  and  state,  and  the  completeness  of  registration  in- 
creased in  direct   ratio  to  the  increase  in  public  health   facilities   for  enforc- 


Table  ;i5. 

Diphtheria  and  Ckoup — Illinois  and  Chicago. 

Number  of  Cases  and  Deaths  1900-1907  and  Death  Rates  per  100,000 
Population. 


Entire 

State. 

Chicago. 

Year. 

Death.s. 

Rate. 

Cases 
reported. 

Deaths. 

Rate. 

1900 



3,033 
2,237 
2,760 
3.300 
2,607 
2,901 
4,457 
5,338 

840 
615 
627 
637 
409 
433 
654 
655 

49.5 

1901 

29.4 

1902 

1,079 
1,175 
881 
825 
1,022 
1,015 

21.6 
23.1 

17.1 
15.7 
19.2 
18.9 

34.8 

1903 

34.4 

1904 

21.5 

1905 

22.2 

1906 

27.7 

1907 

27.1 

Table  36. 
Mortality  from  Diphtheria  in  Illinois. 


Year. 

1921. 

1922. 

1923. 

1924. 

1925. 

1926. 

\i 

1,478 
22.3 

1,181 
17.6 

811 
11.9 

470 
6.8 

409 
5.7 

411 

R: 

te  pel'  100.000 , 

5.7 

ing  the  notilication  requirements  of  health  otticers.  I'airlv  satisfactoi")-  case 
registration  dates  from  ]!)(•;  in  Chica,go  and  from  191 1  for  down-state.  For 
all  jn-actical  pur])oses  the  case  re|iorls  were  complete  subse(|uent  to  these 
ye;ir.^. 

Free  A)itil o.vni. 

(  hicago  introduced  a  system  for  snp]>lying  antitoxin  at  reasonable  i)rices 
from  convenient  stations  in  is'.Ki.  A  -imilar  >ystem  was  created  for  the 
State  in  l!H)."i  by  a  legislative  enactment.  In  I!Hi;  iJu'  State  Board  of  Health 
began  the  free  distribution  of  antito.xin  to  all  citizens.  I'or  this  purpose  an 
a]5propriation  of  !i^l.'),0()0  was  made  in  ihai   \ear.      1  )istvibution  was  effected 


TiEALTII    COXUITIOXS   AKTRR    ISTT 


:3:>: 


through  a  system  of  agents,  usuall_\-  hjcal  druggists,  one  of  whom  was  located 
in  every  county  seat  with  two  or  more  in  all  of  the  larger  communities. 

This  practice  [irevailed  continuously  and  is  still  in  vogue.  It  was  satis- 
factory except  that  unforseen  epidemic  conditions  from  time  to  time  prior 
to  l!i"M  exhausted  the  funds  apiiropriated  and  created  a  shortage  in  the  anti- 
toxin >upply.  This  resulted  in  hard>hips  the  character  of  which  may  l)e 
readily   surmised.     An  emergency  ajipropriation   was  made  hv  the  General 


Table  3T. 
Cases  of  Diphtheria  in  Illinois. 


Year. 

Jan. 

Feb. 

Mar. 

.\l.r. 

1 
May.  1 

June. 

Jul.v. 

A,., 

•Sept. 

Oct. 

Nov. 

Dec. 

Total. 

■ 

1916 

973 

810 

736 

559 

1 
640  1 

643 

471 

525 

797 

1,564 

1,627 

1,337 

10,682 

1917 

1,263 

1,072 

1,312 

1,124 

1,141 

930 

890 

722 

1,212 

814 

2,046 

1,161 

13,687 

1918 

1,028 

649 

751 

665 

565 

566 

487 

362 

604 

990 

703 

705 

8^075 

1919 

731 

769 

665 

635 

668 

470 

541 

528 

992 

1,898 

2,050 

1,505 

11,452 

1920 

1,139 

93S 

1,058 

778 

793  I 

656 

624 

454 

904 

1,907 

2,700 

2,343 

14.294 

1921 

1,874 

1,364 

1,350 

1,215 

1,085  1 

944 

744 

848 

1,613 

3,667 

3,503 

2,584 

20,793 

1922 

1  1,918 

1,361 

1,211 

863 

820  i 

793 

576 

•654 

880 

1,844 

2,297 

1,945 

15,162 

1923 

1  1,697 

1,090 

1,032 

727 

678  1 

532 

392 

411 

607 

1,114 

1,318 

1,118 

10,716 

1924 

1  1,007 

790 

671 

577 

464 

378 

367 

269 

416 

557 

693 

664 

6,853 

192,5 

1      584 

438 

439 

391 

370 

323 

287 

266 

273 

490 

584 

541 

5,0C6 

1926 

486 

392 

357 

327 

300 

367 

232 

204 

273 

493 

381 

519 

4,531 

Talile  ;3S. 
Diphtheria — Morciditv,  Mortality  and  Fatality  Rates. 


Po|mlati..n. 

Cases. 

Ilea  Ills. 

Per  100,000  people. 

IJeaths 

Cases. 

Deaths. 

i;er  100 
cases. 

1917-18 

I91S-19 - 

1919-20 

1920-21 

1921-22 

1922-23 

6,310,856 
6,398,068 
6,4,S5,2S0 
6.572,492 
6,659.704 
6,746,916 
6,834,126 
6,921,344 
7,092,000 

11,000 
8,060 
12,876 
16,764 
19,901 
13,883 
8,853 
5,330 
4,666 

1,527 

979 

1,061 

1.243 

1.25S 

989 

647 

400 

410 

174.3 
125.9 
198.5 
255.1 
298.9 
205.8 
129.5 
79.9 

24.1 
15.3 
16.3 
18.8 
19.2 
13.3 
9.5 
5.8 

13.8 
12.1 
8.2 
7.4 
6.3 

1923  24 

1924-25 

1925  26 

-2 

Assembly  early  in  1!)21  to  cover  immediate  needs  and  subsequent  to  that  time 
the  biennial  grants  were  ample  to  meet  all  requirements. 

With  the  discovery  and  use  of  diphtheria  antitoxin  ilic  deaih  rate 
throughout  Illinois  declined  very  rapidly.  The  rate  of  s.")  per  Kiii.ood  i)opu- 
lation  in  1886  was  cut  to  only  1~,  by  lUO"^.  This  marvelous  drop  in  the  death 
rate  caused  many  of  the  enthusiastic  special  workers  in  the  field  of  preven- 
tive medicine  anil  public  health  to  prophesy  that  the  year  of  1925  would  find 
di])hlheria  wijied  oli'  the  face  of  the  earth.     Thev  based  this  forecast  on  the 


358 


IIKAI.TH   COXniTIONS   AI-'TKR    IS'l^ 


facts  ihal  cdinpl'lc  in  I'uniiation  existed  in  rei^anl  lu  the  causative  at^ont  of 
fliphtlieria.  tlial  anlituxin  wniild  cure  it  and  that  anliluxin  wuuld  t;i\'e  tem- 
[lorary  inmnniiiy  id  exiiii>ed  person^. 

A  >tU(ly  iif  the  Chicago  tii^uro  and  alsd  the  State  ligures  (see  Fig.  23) 
show  tiiat  Ironi  11)()",>  to  \'J22  the  rechicticm  in  diplitheria  mortality  was  very 
small.  The  failure  to  lower  the  diphtheria  death  rates  cluriniL;-  the  two  de- 
cades may  he  t-xplained  in  part  hy  the  following  factors: 

I.  Ignorance  (hiring  ])art  of  this  time  of  the  role  ]>layed  h_\-  diphtheria 
carriers  in  sjjreading  the  disease. 


Tahle  :;!!. 
Diphtheria  Carriers. 


Year. 

Jan. 

Feb. 

Mar. 

Apr. 

Ma.v. 

June. 

Jul}-. 

Aug. 

Sept. 

Oct. 

Xov. 

IJec. 

1921  1 1 1 

179 
136 
346 
340 
242 
118 

174 
117 
227 
2S9 

ISl 
67 

292 
257 
286 
262 
167 
92 

480 
429 
432 
337 
2=9 
145 

516 
676 
522 
417 
310 
164 

420 

1922  

1  270 

239 
306 
383 
207 
119 

235 
255 
327 
259 
134 

165 
249 
285 
186 
122 

139 
3.;3 
284 
287 
126 

214 
288 
227 
244 
89 

477 

1923  

455 

527 

577 
292 

137 

1926  

148 

242 

Table  4U. 
Deaths  from  Diphtheria  in  Illinois  bv  Months. 


Year. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

July. 

Aug. 

Sept. 

Oct. 

NOV. 

Dec. 

Total. 

1918 

146 
100 
121 
137 
181 
133 
83 
47 
38 

105 
92 
108 
122 
108 
88 
34 
23 
37 

100 
91 
68 
93 

120 
74 
41 
29 
35 

94 
63 
83 
88 
74 
59 
38 
33 
32 

83 
69 
76 
92 
88 
36 
36 
29 
26 

66 
44 
47 
84 
45 
27 
32 
27 
24 

66 
60 
44 
56 
43 
26 
33 
23 
32 

53 
48 
47 
81 
46 
36 
16 
25 
14 

77 
89 
64 
92 
75 
45 
31 
24 
24 

159 
135 
126 
231 
132 
89 
37 
46 
53 

102 
141 
181 
223 
130 
107 
44 
51 
52 

91 
112 
165 
179 
139 
91 
55 
52 
44 

1919 

1923  

1924 

811 
480 

1925  

2.  Self-medication  of  illnesses  regarded  as  nothing  more  serious  than 
severe  sore  throat. 

;).      Delayed  medical  service  in  cases  of  diphtlieria. 

4.  Too  >mall  doses  of  antitoxin. 

5.  Inahility  to  produce  in  susce])til)le  persons  anything  hut  temporary 
immunity. 

The  ne.xt  great  ste])  toward  controlling  diphtheria  hegan  in  l'.)i:l  when 
Schick  di^co\■ered  tlu'  skin  leM  that  hears  hi^.  name  and  which  nia\'  he  used 
to  determine  which  persons  are  >u^ceptihle  to  di])htheria  and  which  are  not. 
In  the  same  year  I'.ehring  started  to  using  a  mixture  of  toxin  and  antito.xin 
as  a  pernianmi    pre\enli\e  against   diphtheria.      In   tlie  course  of   time   hoth 


HEALTH   CONDITIONS   AFTllR    187^  359 

of  these  procedures  came  to  be  part  of  the  routuie  practice  in  fighting  diph- 
tiieria  in  lUindis  and  it  is  to  the  prdnidtiim  and  practical  appHcation  of  these 
two  things  that  credit  is  given  for  tlie  remarkable  decline  in  diphtheria  since 

P(ipiil(iri-iiif/  T nxiu-Antitoxin . 

Like  anlitoxin  at  first  toxin-antitoxin  was  regarded  with  distinct  skepti- 
cism (in  the  part  of  doctors  and  the  public  so  that  it  came  into  more  or  less 
general  use  (|uite  gradually.  The  Schick  test  required  time  and  considerable 
skill  but  its  empldyment  before  administering  toxin-antitoxin  was  advocated. 
This  was  ruKither  ditticully  in  the  wav  nf  generalizing  immunization  against 
diphth.'ria. 

Table  41.     , 
Deaths  and  Death  Rates  from  Diphtheria  in  Illinois. 

Rate  per 
100,000 
Year.  Xo.  ilealhs.       iiopulatiiin.  Year. 

I860  1,109  70.0  1009  --- 

1870  1,1S9  59.0  1910 

1880  3,7S3  122.9  1911 

1881  2,924  92.7  1912 

1882   ----  2,172  67.2  1913 

1883   2,2111  66.6  1914 

1884  2,J19  68.6  1915 

1885   -  .  2,7;5  79. ,S  1916 

1886  .- 3,997       113.3  1917 

1890  3, .561        93.  191.S 

1900  2,067        42.8  1919 

1902  - -  .    1,076        21.6  1920 

1903  - ...    1.175        23.1         1921 

1904  - .---  .     884        17.1  1923 

1905  825        15.7         1923 

1906  1,022        19.2  1924 

1907  1,015        18,9          1925 
190S  979        17.8  1926  


Rate  per 

100,000 

.  .leaths. 

population 

1,001 

18. 

1,332 

23.8 

1,302 

22.7 

1,414 

23.4 

1,347 

22.8 

1,092 

18.2 

1,130 

18.5 

1.356 

21.8 

1,725 

27.7 

1,142 

17.9 

1,044 

16.2 

1,128 

17.2 

1,478 

22.2 

1,181 

17,4 

811 

11.9 

Experience  came  tn  the  rescue.  .\  few  pioneers  all  over  the  cnuntry 
began  giving  toxin-antitoxin  t(i  all  children  under  their  cniitrol  without  ref- 
erence to  the  Schick  susceptibility  test.  One  nf  these  was  the  medical  offi- 
cer of  the  fraternity  school  at  Mooseheart,  Illinois,  where  more  than  l,t>(i() 
children  are  constantly  enrolled.  Beginning  with  1 '.(•;;()  all  children  in  the  in- 
stitution have  been  immunized  with  toxin-antitoxin,  newcomers  getting  the 
immunizing  doses  upon  arrival.  No  case  of  diphtheria  developed  there  to 
date  subse(|uent  to  V.)'M  although  the  previous  history  showed  Ki  to  .'iD  cases 
annually. 

Statistics  al'-o  came  in  with  helpful  suggestions.  Thev  pointed  out  that 
by  far  the  heaviest  losses  of  life  from  iliplitheri:i  were  among  children  less 
than  si.x  ^-ears  old. 


3fi0 


IIKAI.TII    COXDITIOXS   AKTKR    ISTT 


TIius  aboul  \'>'i'i  the  Slati-  IX-parlmcnt  of  Public  Health  began  to  ad- 
vocate tbe  use  of  toxin-antitoxin  in  children  under  eight  without  regard  to 
the  Schick  test,  A  mnnber  of  voluntary  and  professional  organizations 
elected  lo  lend  ibeir  influence  to  the  cause  of  diphtheria  eradication  and  some, 
like  the  federation  of  women's  clubs  and  the  parent-teacher  associations  be- 
came quite  active  in  the  campaign. 

In  the  meantime  the  State  had  beyun  to  distribitte  material  for  making 
the  Schick  test  and  toxin-antitoxin  without  local  cost  to  any  citizens  who 
desired  to  use  either  or  both.     Previously  a  field  laboratory  equipment  had 


!  rnTrnrriTrrinT'r 

diphtheria; 
in  iLLinois 

1860-1926 


Fk; 


been  ])urchased  and  the  .Slate  I'mployed  bacteriologists  who  were  prejiared 
to  go  at  once  to  the  scene  of  ontiireaks  which  had  got  beyond  local  control. 
Not  onl\-  so  but  branch  laboratory  service  had  been  developed  liy  the  State 
for  tbe  i)uriK)se  of  expediting  the  diagnosis  of  diphtheria. 

.Ml  of  these  factors  counted  in  the  manifest  success  toward  ridding  the 
State  of  diphtheria.  The  first  step  was  the  realization  that  diphtheria  is  con- 
tagious and  is  spread  from  person  to  person.     That  took  place  about  ISOO. 

1  lien  came  antitoxin,  placed  on  the  market  in  lsii."i.  The  next  imiiort- 
aiit  iiieaMue  was  tbe  laboratory  diagnosis  of  diphtheria.     This  Ijegan  as  an 


HEALTH   COXDITIOXS  AFTER    ISTT  3(51 

official  function  of  the  State  in  I'JOi  when  the  laboratory  was  started.  It 
developed  until  five  branch  laboratories  located  at  convenient  points  offered 
prompt  service  in  diphtheria  cases  to  all  parts  of  the  State  without  local  cost. 
In  liilT  a  field  diagnostic  laboratory  ovitfit  was  put  into  service  also. 

Following  the  introduction  of  free  laboratory  service  came  the  free 
distrilnuion  of  antito.xin,  undertaken  b_\'  the  State  in  I'.H)',  and  continued. 
Then  came  the  Schick  te>t  and  toxin-antitoxin  in  IDl.'!  and  the  adoption  of 
both  by  the  State  about  lii-20. 

The  downward  trend  of  di])htheria  was  due  to  the  organized  use  of  these 
factors.  As  each  came  into  prominence  a  nt-w  advantage  over  the  disease 
was  gained  and  a  new  declevity  in  mortality  from  diphtheria  dated  from  its 
use  on  a  considerable  scale. 

Reference  to  Figure  ^^i  and  the  various  tables  accompanying  this  article 
tell  the  story  of  how  rapid  the  progress  against  diphtheria  has  lieen.  Not 
only  has  the  prevalence  ftnd  mortalitv  declined  but  the  jiercenlage  of  fatal 
cases  has  gone  down. 

After  l!i-2i  improvement  in  the  mortality  rate  from  di])htheria  was  phe- 
nomenal. The  number  of  deaths  reported  for  li)26  in  Illinois  was  less  than 
one-third  of  the  number  reported  in  I!I51.  Figures  for  the  intervening  years 
are  shown  in  Table  ;)ii. 

Tuberculosis. 

Tuberculosis  in  Tllimiis  subsei|uent  to  is;;,  may  be  viewed  in  two  per- 
iods, the  one  prior  to  1!M0,  during  which  time  n<it  nnich  was  accomplished 
in  lowering  the  death  rate,  and  the  other  from  I'.HO  to  date,  during  which 
the  trend  of  mortality  was  definitely  downward  as  a  result  nf  the  systematic 
control  measures  instituted. 

The  period  prior  to  111  1(1  may  be  cunsidered  in  two  phases,  the  one  be- 
fore and  the  other  after  the  time,  in  the  early  nineties,  when  the  tubercle 
bacillus  became  generally  accepted  as  the  causative  agent.  Although  the 
tubercle  bacillus  was  discovered  in  1882,  it  took  approximately  another  de- 
cade for  this  fact  to  become  accepted  generally  enough  to  aft'ect  the  manner 
of  handling  the  malady  in  curative  and  preventive  medicine. 

The  course  of  tuberculosis  in  Illinois,  as  shown  by  the  annual  death 
rates,  as  far  as  these  are  available,  is  illustrated  in  Figure  24 

This  chart  shows  that  in  the  first  period,  the  rate  remained  practicallv 
stationary  for  10  years.  Then  for  another  decatle  it  manifested  a  ten<lency 
to  increase.     Toward  the  end  of  the  period  there  was  a  slight  fall. 

The  second  period  is  marked  by  a  pnmnnnced  initial  decline  that  ccmtin- 
ned  until  about  1917  when  the  nicirtalit\'  rate  jumped  up  again  u>  the  level 
which  characterized  the  diseases  during  the  first  decade  of  the  twentieth  cen- 


3G2 


lli:\l,rll   CONDITIONS  AI-'TI'l;    \s',', 


tun'.  This  iiKTcase  probribly  had  some  rflaticui  tn  the  Wdvld  War.  'I'he 
strain  of  that  ciiiergency  together  with  deprivatimis  in  food,  high  pressure 
working  cmiilititins  and  new  kinds  of  cx])osures  pr(ihal)ly  caused  a  rekindhiig 
of  tuiierculdsis  in  inaii\'  people  in  whom  il  had  lieen  arrested  or  quiescent. 

.\t  an\-  rate  I'.Ms  was  the  jieak  ninrtality  year  in  the  second  period. 
After  lliat  dale  a  stead\'  dechne  marked  the  mortahty  from  tuberculosis. 
Not  oni\-  had  tlie  time  arri\ed  when  resuUs  from  eonlrnl  measures  were  to 
be  expected  hut  a  new  zeal  and  added  mdinenlum  characterized  anti-tuber- 
culosis campaigns  in  the  Slate.     Good  economic  conditions  also  prevailed. 


TUBERCULOSIS-ALL  FORnS 

in  iLLinas       ,n 

1860-1926  ^^ 

C  STATISTIC?   UrtAVAILABLE    FOR   OPEh   YEARS) 


making  pussible  the  extension   of   pre\enti\e  work   on  a   larger   scale   than 
would  otherwise  have  been  the  case. 

Earlij  Altitii'lr. 

The  carK  \iilumes  of  the  annual  reports  of  the  State  Moard  of  Ilealtb 
contain  practicalK-  no  reference  to  tuberculosis.  This  is  evidence  thai  the 
disease  pro\dkeil  little  thoughl  among  saniiarians  then.  The  efforts  of  health 
officials  concerned  |iidhlem-,  which  were  regarded  as  more  urgent  at  that 
time.      These  included  the  protection  of  the  inhabitants  against  the  invasion 


HEALTH    CONDITION'S   AFTER    187 


363 


of  such  pestilential  diseases  as  cholera,  yellow   fever,  and  smallpox,  and  li- 
censing of  practitioners  of  medicine. 

Furthermore,  the  fact  that  the  infectious  nature  uf  tulierculusis  had  not 
been  definitely  proven,  while  the  sanitary  precauliun  to  ])revent  the  spread 
of  cholera  and  similar  diseases  had  apparently  been  effective  where  they 
had  been  carried  out,  gave  everv  cause  for  the  Board  to  proceed  along  these 
established  lines  at  the  time. 

Table  53. 


Cases  of  Tuberculosis  Reported  bv  Months 

IN   1 

LLINOIS. 

Year. 

Jan. 

Feb. 

Mar. 

Apr. 

May.     June. 

July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

Total. 

L.._...L_.... 

1              1 
; 

1917 

172 

2,485     2,415 

1,976 

1,720     2,249 

2,619 

2,495 

2,484 

892 

311   1   4,111 

23,929 

1918 

1,840 

1,142      1,722 

1,446 

1,602      1,353 

1,.563 

1,182 

973 

891 

1,208  1      637 

15.559 

1919 

1,390 

1,397      1,430 

1,923 

1,586      1,723 

1,720 

1,447 

1,627 

1,719 

1,693  1  1,580 

19,241 

1920 

1,433 

1,164      1,.S20 

1,320  1  1,295      1,46.S 

1,065 

729 

1,209 

1,012 

938  1  1,114 

14,563 

1921 

989 

1,103      1,366 

1,253 

1,208 

1,283 

1,508 

1,003 

1,237 

1,100 

1,142     1,235 

14.427 

1922 

1,153 

1,111      1,685 

1,229 

1.640 

1,417 

1,464 

1,171 

1,164 

1,429 

1,634      1,386 

16,483 

1923 

1,775 

1,161   1  2,489 

1,403 

1,610 

1,351 

1,151 

1.122 

1,096 

1,385 

1.083         886 

16,512 

1924 

1,328 

1,077  1  1,111 

1,482 

1,239 

1,223  1  1.582 

1,799 

1,135 

1,2.37 

880  1      925 

15,018 

1925 

907 

1.182  1  1,143      1,101 

1,151 

1,190  1   1,051 

825 

1,166 

1,015 

1,332  1  1,941 

14,004 

1926 

954      1,132  1  1,359  1  1,755 

1,853 

1,793      1,463 

1,738 

1,291 

1,399 

1,131  1  1,129 

16,997 

1927 

1,518      1.175  1   1.329  1   1.414 

1,157 

1,362     1.040 

Table  'A. 


Deaths 

FROM  Tuberculosis  in  I 

LLINOIS  BY  Months 

Year. 

1 

Jan.    !   Fell. 

1 

Mar. 

Apr. 

May. 

June. 

July. 

Aug.      Sept. 

Oit. 

Nov. 

Dee. 

Total. 

1916 

' 

1 

1 

1917 

1918 

724 

677 

876 

939 



818 

671 

596 

585 

581 

742 

720 

650 

8,579 

1919 

728 

721 

756 

768 

712 

612 

610 

553 

454 

509 

459 

513 

7,395 

1920 

639 

737 

631 

626 

628 

563 

524 

468 

450 

423 

431 

448 

6,568 

1921 

506 

455 

571 

505 

548 

428 

447 

444 

449 

435 

375 

456 

5,617 

1922 

492 

477 

576 

551 

547 

468 

445 

440 

384 

408 

395 

437 

5,620 

1923 

489 

506 

559 

542 

527 

474 

448 

421 

410 

410 

408 

378 

5,572 

1924 

544 

469 

560 

505 

543 

482 

446 

416 

409 

420 

424 

424 

5,642 

1925 

505 

433 

555 

504 

502 

511 

470 

386    1    415 

407 

408 

441 

5,537 

1926 

454 

407 

579 

531 

556 

486 

441 

410     1     408 

438 

347 

438 

5,495 

1927 

1 i 

At  the  beginning  of  the  semi-centennial  period  in  the  year  1877.  little 
was  known  about  the  cause  and  prevention  of  tulierculo^is.  Ihiwcver.  as 
early  as  ]S(i],  France  had  established  h(>si)itals  for  the  poor  tuberculous 
children  of  Paris.  In  I.S(i.")  it  was  demonstrated  that  ttiberculosis  could  be 
transmitted  to  the  lower  animals  by  inoculating  them  with  diseased  tissue 
from  tuberculous  luini,-ni  lungs. 

The  attention  of  the  people  of  Illinois  was  first  attracted  lo  the  serious- 
ness of  this  disease  bv  the  high   death   rate  at    .state   instiuuioits,      .\s  earlv 


364  iii:.\Lii[  lO.vDiTioxs  a1'-ti:k  1<ST" 

as  l.s;n,  thr  death  rate  I'nim  iul)ercul()>is  at  llie  State  iieiiilentiary  Ijegan  to 
concern  the  inaiia.i,'enieiit  nl'  that  iii>tituticin.  A  rejjort  made  in  1899  showed 
a  10-year  averat^e  nicrlaHly  of  Jii.o  per  thuusand  inniates ;  the  average  age 
of  inniate>  lieing  ;)"i  years  and  the  average  term  of  commitment  being  two 
years.  Warden  Mnrphy's  re])ort  in  1(S9.')  showed  'A)  cases  of  tuberculosis, 
29  deaths,  and  ■.'(;  discharges;  and  of  those  sulTerinL;  from  lul)erculosis  as 
high  as  ^'-i  ]jcr  cent  had  died  from  this  disease  in  this  institution. 

Unfortunately  there  are  no  accurate  records  available  during  this  early 
]>eriod  showing  the  [Prevalence  of  tuberculosis  in  the  State  as  a  whole,  except 
the    I'nited    States   decennial   census   reports   of   deaths.         These   give   the 

Table  55. 

Anxu.vl  De.vtiis  .xNii  De.atii  Rates  from  Tuberculosis  in  Illinois. 
— All  Forms. 


Rate  per 

Rate  per 

100,000 

100,000 

Ycir. 

No.  ilciths. 

jiopulation. 

Ycav. 

No.  deaths. 

population. 

1860  , 

113.7 

1906 

6,899 

129.8 

7,142 

1S70  

145.6 

1908  

6,944 

126.8 

1909   

7,078 

1880  

4,645 

150  '.. 

1910  

7,049 

1881   - 

3,624 

111.7 

1911   

6,509 

1S,S2 

2.385 

73.8 

1912  .- 

6,212 

106.5 

ISS'i 

3,2.55 

98.5 

1913  

6,371 

107.6 

ISM 

3,452 

102.5 

1914  

6,521 

104.8 

ISS.i 

3,S66 

111.9 

1915  

7,816 

128.1 

1SS6  - 

4,472 

126.7 

1916  

8,408 

135.6 

1917  

8,065 

129.4 

1890  . 

5,69S 

14S.9 

1918  

8.579 

128.7 

1919  .- 

7,395 

114.7 

1900 

6,7S8 

140.7 

1920  

6,568 

6,S95 

138.3 

5,617 

1902   _. 

1922  -- 

5,620 

83.8 

1903    - 

7,032 

13S.7 

1923  

1904  .... 

7,234 

140.5 

1924  

1905  .- 

6,.S91 

131.7 

1925  

5,537 

1926  

5,495 

76.2 

deaths   from  tuberculosis  as   follows:      I,<il5.   in   ISSO,  and   5.fi98.   in   1890 
representing  a  rate  of  150.9  and  14:S.9,  per  10(1,0(10  respectively. 

Siiicf  DiscdriTfi  nf  Cause. 

It  was  the  discovery  liy  Koch  in  ISS".',  of  the  bacillus  of  tuberculosis  as 
the  causative  agent  of  the  disease,  that  elicited  the  interest  and  study  of  the 
medical  profession,  and  subsequently,  the  attention  of  laymen,  to  the  spread 
of  the  disease  and  the  measures  necessary  for  its  prevention. 

(  >n  May  'i2.  ISIKI,  Dr.  ('.  W.  Olson  of  Lombard,  Illinois,  read  a  paper 
on  "School  Hygiene  an<l  Sanitation"  before  the  State  Board  of  Health  in  a 
joint  meeting  with  tlie  Slate  sanitarv  association,  in  which  he  recommended 
that  tuberculous  teachers  and  pupils  be  excludeil   from  the  public  schools. 


HEALTH   CONDITIONS   AFTER    187  7  365 

Thereupon  Dr.  Scott,  Secretary  of  the  State  Board  of  Heahh  otTercd  a  re'io- 
lution  as  follows :  "Resolved  that  a  committee  be  appointed  by  the  State 
Board  of  Health  and  the  Sanitary  Association  tu  confer  with  the  State 
Superintendent  of  Pubhc  Instruction  and  the  county  superintendents  of 
schools  to  draft  such  needed  amendments  to  the  school  laws  of  the  State  a- 
will  render  it  necessary  that  teachers  Cjualify  physically  as  well  as  mentall\- 
before  receiving  certificates  to  teach,  and  that  a  thorough  knowledge  of 
school  hygiene  be  included  in  the  recommendations  of  all  teachers ;  also  to 
formulate  such  other  amendments  as  will  place  all  public  schools  directly 
under  medical  supervision  and  inspection." 

In  accordance  with  a  joint  resolution  by  the  General  Assembly  the  State 
Board  of  Health  made  an  investigation  of  tuberculosis  in  the  State  in  liiiU). 
The  report  to  the  Governor  recommended  the  establishment  and  maintenance 
of  a  State  tuberculosis  sanatorium.  This  report  after  reviewing  the  tuber- 
culosis situation  and  citing  figures  to  show  its  economic  ini])ortance,  pre- 
sented the  following  as  part  of  arguments  for  a  sanatorium  ; 

"Sanatoria,  are  institutions  designed  for  the  open  air  treatment  of  consump- 
tives under  medical  direction,  embodying  ideal  hygienic  and  educational  methods. 
viz:  the  isolation  of  the  patient,  the  destruction  of  sputa  and  morbid  excretations 
which  contain  bacilli,  thus  removing  from  him  the  danger  of  infecting  others  or  of 
reinfecting  himself.  Under  the  constant  supervision  of  a  medical  officer,  he  is  edu- 
cated in  hygienic  principles,  there  is  a  strict  regulation  of  his  daily  life  and  such 
measures  are  enforced  as  may  be  indicated  by  the  needs  of  the  patient.  There 
is  a  systematic  regulation  of  rest  and  exercise  according  to  the  varying  condition 
of  the  patient,  a  carefully  chosen  dietary,  an  abundance  of  wholesome  food,  and 
constant  exposure  to  fresh,  pure  air  and  sunshine,  promoting  oxygenation  of  the 
tissues,  together  with  special  remedies  administered  for  symptoms  as  they  may 
arise. 

"To  quote  a  prominent  clinician:  'A  patient  outside  the  sanatorium  is  dis- 
inclined to  accept  the  yoke  of  a  rigid  and  severe  discipline.  In  the  sanatorium 
nothing  is  left  to  his  caprice,  he  never  receives  recommendations  more  or  less 
vague,  but  rest,  exercise  and  alimentation  are  measured  and  even  the  cough  is  dis- 
ciplined. This  almost  military  education  creates  an  influence  very  favorable  to  the 
evolution  of  recovery  and  assures  success  of  therapeutic  means,  and  the  patients 
rapidly  acquire  habits  of  hygienic  discipline  which  they  continue  in  their  homes.' 

"At  the  International  Medical  Congress  for  the  consideration  of  tuberculosis, 
which  met  in  Berlin  in  May,  1S99,  the  world's  most  prominent  investigators  of  the 
disease  were  present.  It  was  tlie  unanimous  conclusion  of  this  notable  assemblage 
that  all  means  of  controlling  tuberculosis,  preventive  and  curative,  were  combined 
in  the  conception  of  the  sanatorium. 

"As  far  back  as  can  be  remembered,  consumptives  have  sought  localities 
where  they  could  have  the  benefit  of  a  mild  sunny  climate  possessing  either  a  high 
altitude  or  a  marine  atmosphere.  The  cure  of  consumption  by  climate  has  be- 
come traditional,  but  experience  in  sanatorium  work  has  proven  that  the  value  of 
any  special  climate  or  altitude  or  atmosphere  has  been  exaggerated.  Weber,  who 
can  speak  with  higher  authority  on  this  subject  than  any  other  writer,  says:  'The 
blind  confidence  that  has  existed  in  climate  influence  has  caused  neglect  of  other 
necessary  hygienic  measures  and  has  frequently  caused  an  aggravation  of  the 
disease.'  It  is  now  conceded  that  there  is  no  climate  possessing  immunity  from 
consumption.  Climatic  conditions  are  tar  from  exercising  the  salutary  influence 
attributed  to  them,  and  excepting  in  the  extreme  zones  of  the  earth,  the  cure 
can  be  effected  wherever  the  air  is  pure  without  extreme  changes  of  temperature." 


3(^Cl  IIEALTT!    rr)\I)ITIONS  AFTER    187? 

'I"he  State  Hoard  of  Hcallh  Uv>[  dfclared  tubcrculiisis  to  he  a  contagious 
disease  in   IIMIl . 

A  second  report  was  siilmiilleil  lo  the  (iovcrnor  in  I'.H)-.'.  recommending 
the  estabhslnnt'!ii  of  a  Stale  sanatorinm.  .Vttenlion  was  calle(l  to  the  fact 
tliat  the  records  of  the  State  showed  from  7,()t)U  to  8,t)()0  deaths  ])er  year  from 
tuberculosis  and  that  there  were  tnore  deaths  from  tuberculosis  than  from 
typhoid  fever,  whoopiing  cougii,  measles,  scarlet  fever,  and  smalliiox  com- 
liined. 

Numerous  attempts  were  made  to  gi't  pu1)Hc  appropriations  for  a  State 
sanatorium  but  these  efforts  failed. 

Tuberculosis  was  the  suljject  of  a  symposium  on  the  occasion  of  the 
annual  meeting  of  tiie  Illinois  State  Medical  Society  held  at  Bloomington, 
Illinois,  in  I'.iOI.  This  was  participated  in  li\'  members  of  tlie  State  Board 
of  I  lealth.  {'"ollowing  this  a  circular  was  printed  liv  the  Board  entitled 
"Cause.  Prevention  and  Cure  of  Tuberculosis."  'i'his  was  distributed  in 
July,  and  during  the  year  it  was  necessary  to  turn  out  four  editions,  the 
last  consisting  of  lOO.OOii  cojjies.  '{"his  circular  was  distributed  freely  dur- 
ing the  following  year.  It  was  in  1IK)1  also  that  Dr.  T.  B.  Sachs  published 
the  report  of  his  intensive  studies  on  the  incidence  of  tuberculosis  in  the 
Jewish  district  on  the  west  side  of  Chicago.  The  cases  found  in  a  house- 
to-house  survey  and  through  dispensary  records  were  shown  on  a  spot  map. 
and  were  so  numerous  that  the  study  attracted  a  great  deal  of  attention. 

The  report  and  charts  a|)iiealed  especially  to  State  Senator  Edward  J. 
Glackin.  himself  a  resident  of  the  district,  and  his  interest  later  found  ex- 
]>ression  in  the  drafting  of  bills  for  sanatoria  which  he  introduced  in  the 
legislature.  The  first  of  these  was  for  a  .State  sanatorium,  in  1!)05.  which 
failed  to  pass.  The  next  one  provided' for  the  establishment  of  municipal 
sanatoria  which  will  be  referred  to  later. 

^1  iili-t  ilhi  iciildsis  E  If  arts  Oriidttizcil. 

A  meeting  was  held  at  Chicago  on  December  1."),  1!H)4,  for  the  purpose 
of  bringing  together  all  of  the  organizations  activeU-  engaged  in  the  pre- 
vention of  tuberculosis  in  Illinois.  This  meeting  was  attended  by  represent- 
atives of  the  State  Board  of  Health,  of  the  State  Board  of  Charities,  the 
Chicago  Medicrd  Society  ;in<l  the  Chicago  \'isiting  Nurses'  Association. 
The  object  of  the  meeting  was  to  concentrate  the  forces  engaged  in  the  work 
of  ])reyenlin,g  tuberculosis  in  Illinois,  and  to  torm  an  association  for  this 
])urpose. 

Ileretofore.  three  distinct  mo\cmenls  against  tuberculosis  had  been  car- 
ried forw.ard  in  Illinois.  The  C  onnnittt'e  on  tlu'  Prevention  of  Tuberculosis 
of  the  \isiiing  .Xurses'  .Association  of  Chicago  had  for  more  than  two  years 
been  at  work  in  Chica.go.     The  State  Board  of    I  lealth  had   been  active  in 


HEALTH    CONDITIONS  AFTER    ISTT  3()~ 

educational  work.  The  State  Medical  Society  had  been  active  as  far  as  its 
facilities  permitted. 

At  the  preliminary  meeting-  of  the  conference,  a  committee  on  organ- 
ization was  ajjpointed  with  instruction.s  to  prejjare  the  necessary  ]iy-la\\  s  for 
a  new  society,  and  to  iKjininate  a  hoard  (if  directors  to  report  to  a  general 
meeting  to  be  called  later. 

The  committee  met  on  December  1(1.  1!H)4,  and  prciceeded  to  efifect  an 
organization  to  be  known  as  the  Illinois  Association  for  the  Prevention  of 
Tuberculosis,  in  which  all  of  the  groujis  interested  would  be  represented. 
A  constitution  and  by-laws  were  drawn  up,  in  be  sulimitted  at  the  first  an- 
nual meeting  scheduled  for  January  I'.i.  I'.i((-"i.  at  the  Public  Librar\-  Building, 
Chicago. 

From  that  time  on  this  Associatic  n,  under  varinus  titles,  was  a  dominat- 
ing factor  in  anti-tuberculosis  work  in  the  .'~'tate.  Due  largely  to  its  efforts 
every  county  felt  the  influence  of  organized  effort  referred  to  at  greater 
length  in  the  chaijter  on  auxiliary  health  organization.  Its  best  work  was 
done  after  1910,  however. 

Organized  efforts  from  the  outset  was  directed  toward  legislation  and 
education.  The  voluntary  agencies  and  the  .State  Board  (if  Health  j(.iined 
forces  in  both  directions.  At  each  meeting  the  ( leneral  Assembly  was  be- 
seiged  with  lobbysts  and  appealed  to  with  bills,  the  first  of  which  usually 
asked  for  a  state  sanatoriiim.  Exhibits  graphically  portraying  the  ravages 
of  tuberculosis  were  displayed  upon  every  opportunity.  They  were  shown 
before  medical  meetings,  teachers'  conventions,  farmers"  institutes  and  even 
the  General  Assembly. 

Having  been  agitated  the  subject  (if  tubercuUisis  anKmg  ])risnners  wmild 
nut  down.  The  situation  at  Joliet  attracted  especial  attention  because  of 
interest  manifested  liv  the  warden  and  because  nf  the  paucity  of  medical 
service  in  the  institution. 

The  agitation  about  tuberculdus  prisoners  was  important  chiefly  because 
of  its  liearing  upon  the  general  situati(  n.  It  brought  the  subject  into  the 
press.  It  made  the  lawmakers  take  notice.  It  helped  t(j  create  a  ])ublic  o])in- 
ion  about  tuberculosis.  The  reforms  in  prison  construction  and  prison  man- 
agement that  resulted  were  good  measures  for  applicati(.in  everywhere,  so 
far  as  the  principles  involved  were  concerned.  The  publicity  brought 
on  1)\-  the  iuMilvement  of  the  jienitentiarv  carried  these  relations  home  to 
large  blocks  of  the  ])0|)ulation  in  an  eas\,  (|uick  way. 

.\nother  dehnite  step  was  taken  by  the  State  Board  of  Health  in  lllOli. 
l.aboralory  facilities  for  the  exaniinati('n  of  sputum  specimens  were  put 
into  operation.  This  off'ered  a  means  for  the  accurate  diagnosis  of  tubercu- 
losis in  many  cases,  and  led  to  the  treatment  at  ;i  more  oiiportune  time  in 
the  ciurse  of  the  disease. 


368  iii;ai.iii  ((iMurioxs  aI'TI-k  li>',', 

It  was  in  l!HMi  alsn  that  llir  iiKivcnu'iil  against  tutjerciilusi.s  in  the 
schools  began.  Tliis  started  in  Chicago  where  nursing  services,  mechcal 
examination  and  \entilaling  facihties  were  proniuteil. 

The  Chicago  Tuhereuhjsis  Institute  secured  the  consent  uf  the  ccininiis- 
sioners  of  Cook  County  in  the  summer  of  1906,  for  the  estahhshnient  of  an 
open-air  camp  for  consum])tives  at  the  Dunning  institution.  'i"he  camp 
was  designed  for  poor  consuni|)tives  and  particularly  for  those  living 
in  the  congested  poorer  quarters  of  the  city.  A  great  deal  of  interest  at- 
tached to  the  results  attaine<l,  as  the  [jroject  was  undertaken  to  i>rove  that 
out-of-door  treatment  was  therapeutically  and  economically  sound. 

The  developments  mentioned  thus  far  had  their  effects.  One  commmiitv 
after  another  began  to  pass  ordinances  re(|uiring  case  reports  and  move- 
ments resulting  in  the  establishment  of  sanatoria,  preventoria,  open-air 
school  rooms  and  dispensary  service  began  to  take  cii  momentum. 

Thus  in  liidii.  I'eoria  passed  an  ordinance  requiring  case  reports.  The 
same  year  Sangamon  County  appropriated  $200  for  providing  tents  in  which 
local  hospitals  could  isolate  tuberculous  patients.  Abovtt  the  same  time  the 
Illinois  Homeopathic  ^ledical  Association  established  an  open-air  sanatorium 
at  Buffalo  Rock  in  LaSalle  County.  A  little  later,  about  1908,  the  State 
Board  of  Health  attempted  to  stimulate  reporting  by  requiring  the  names 
of  persons  from  whom  s]iuluni  was  collected  f(n'  examination  at  the  State 
diagnostic  laboratory. 

Lcfjishifiiin  Si'ciirciJ. 

All  (jf  these  things  brought  ])ressin'e  en(.)Ugh  on  the  Ceneral  .\ssembly 
to  result  in  a  law  enabling  cities  to  build  and  maintain  sanatoria.  This 
took  ])lace  in  1908  after  faihu"e  had  ])ursued  all  efforts  to  secure  a  State 
tuberculosis  sanatorium. 

The  act,  known  as  the  "Glackin  Law",  jirovided  that  u|)on  the  ado])tion 
of  the  propositon  Ijy  a  referendum  vote  by  any  city  a  tax  of  not  to  exceed 
one  mill  on  e\erv  dollar  of  the  assessed  valuation  might  be  levied  to  defray 
the  cost  of  establishing  and  maintaining  such  sanatoria,  and  for  the  care 
and  treatment  of  jjersons  suffering  from  tuberculosis. 

The  citv  of  Chicago  took  advantage  of  the  law  in  1909,  proceeding  at 
once  to  build  a  s;inatorium.  The  same  year  Lake  Count\'  estaljlished  a 
tubercti'osis  sanalorium,  to  lie  maintained  by  the  county,  which  meant  that 
indi,'.;eni  pi'rson>  (jnl\-  could  be  admitted  \\ilhont  charge.  The  (.'li'icago  I'resh 
.\ir  Hospital,  a  piixale  inslilution  conducted  li\-  Dr.  L.than  .\.  Cray,  was 
opened  this  year. 

In  19(i;i  and  191  L  bills  were  .again  iiUrodnced  in  the  legislature  jinnid- 
ing  for  the  establishment  of  a  State  sanatorium,  but  were  not  enacted.     Thus 


HEALTH   COXDITIOXS  AFTER   1877 


369 


the  establishment  of  niuiiicipal  -sanatoria  had  td  he  rcHed  upim  uniil  ll)l."i, 
when  the  legislature  passed  a  law  providing  for  the  estatjlishment  of  such 
institutions  by  counties. 

The  movement  against  tuberculosis  gathered  considerable  momentum  by 
the  work  done  in  Chicago  between  1907  and  1911.  Under  Health  Commis- 
sioner Evans  an  ordinance  prohibiting  the  sale  of  milk  from  tuberculous 
cattle  was  passed,  the  requirements  of  case  reijorts  was  rigidly  enforced, 
disjiensaries  for  diagnosis  and  treatment  were  e^talilished,  and  a  ^pecial- 
ized  nursing  service  was  inaugurated,  an  anti-spit  crusade  was  conducted 
and  withal  a  general  public  sentiment  against  the  disease  was  created  and 


Will    You    Become    a     Crusader? 


In  the  interests  o!  Health,  Gleanlinpss  and 

The  La>v,  you  are  earnestly  requested  to  co-operate 
m  enforcing  the  reasonable  and-  sanitary  regulation 
embraced  in  the  City  Ordinance,  Number  1493; 

"Spitting   is   prohibited     upon    sidewalks,    in 

public   conveyances,    theatres,    halls,  assembly 

rooms,  public  buildings,  or   buildings  where  any 

considerable    number    of   people    gather    or 

assemble    together,    and    in   similar   places  " 


^{ZuT.  /^^irz^f^A^^ 


Commissioner  of 
Chicago  .\ii«i-S|>;Hiiiii  I.ea)!ue 


Reproduced  from  a  circular  used  in  Chicago's  anti-spitting  campaign. 


ptit  to  wijrk.  Alortality  began  to  decline  and  this  made  other  folks  take 
notice. 

The  Association  fur  the  Prevention  of  Tuberculosis  took  on  new  life 
and  reorganized  in  l'.)|n  with  Dr.  W.  .\.  Evans  as  president.  From  that 
time  forward  a  close  cooperation  between  voluntary  and  official  agencies  was 
observed  with  telling  results.  The  law  enabling  counties  to  erect  and  main- 
tain sanatoria  came  in  191.5.  After  that  the  story  is  one  of  increasing  fa- 
cilities for  fighting  tuberculosis  and  ultimately  a  long  anticipated  and  wel- 
comed decline  in  mortality  which  gave  evidence  of  iiermanent  advantage. 

Following  a  well-established  rule,  the  rate  of  progress  in  tuberculosis 
control  did  not  conform  to  a   straight  line.  Ijut   was  interrupted  bv  a   break 


370  iii:al]ii  co.nditioxs  akthk  187T 

or  st(.'|)  liackward  in  l!)ll.  Thai  year  llu-  milk  (irclinancc,  unik-r  which 
Chicas,'c)  was  making-  stu'h  hcadwav  in  its  li^ht  a.i;ainsi  tuhnauldsis,  was  in- 
validated, hy  an  act  iil'  the  leijislatuie  which  iiruhiliited  am  niiiihcipahty 
in  the\Stale  from  re(|uirini;  a  tuhercnHn  test  for  tiie  cattle  I'mtn  which  its 
milk  supply  was  derived;  the  so-called  "SliurtlelT  I-aw." 

After  a  year's  delay,  another  ordinance  was  passed  which  provided  that 
nnlk  sold  must  he  of  a  jjrade  defined  as  "inspected,"  or  else  be  pasteurized 
according  to  methods  set  forth  in  the  ordinance.  No  tuberculin  test  could  be 
required  for  cows  usetl  f(]r  the  production  of  inspected  milk,  but  the  standard 
for  this  class  of  milk  was  so  hi.<,di,  that  the  real  elTect  of  the  ordinance 
was  general  pasteurization. 

But  the  elTect  of  the  State  law  as  a  win  le  was  that  dela\-  and  pro- 
crastination occurred  in  the  purification  of  the  milk  snppl\-  of  the  largest 
city  in  tin-  ."^tate  ;  in  fad  comiilete  pastetirization  of  the  milk  sujiply  was  not 
obtained  until  nearly  li\e  years  later  when  Dr.  John  Dill  Robertson,  on 
July  "i".',  r.iHi.  issued  an  order  dnrini;-  an  epidemic  of  infantile  paralysis, 
definitely   rei|uiriiig  the  pasteurization  of   all   milk   except   certified. 

L'pon  the  recommendation  of  Dr.  John  Dill  Robertson,  Comnfissioner 
of  Health  i  f  Chicago,  the  Municijjal  Tuberculosis  Sanitarium  in  I'.ilG  made 
a  house-to-house  survey  for  tuberculosis,  in  the  central  district  of  Chica.go. 
.\  total  of  1  Ci."),';  0(1  persons  were  examined,  of  wliich  number  l^.G  per  cent 
were  found  to  be  tuberculous.  .V  total  of  ll.'.'S'i  unregistered  cases  were 
found  and  listed  for  superxision. 

In  l:i|(i  the  sanitarium  .-uigmented  the  school  inspection  service  of  the 
luallh  department  by  adding  "id  doctors  and  ."lO  nurses  to  the  force,  with 
the  understanding  that  a  |iart  of  the  wi  rk  of  the  entire  force  would  be 
devoted  to  the  diagnosis  and  ])re\ention  of  tuberculosis  among  pupils  in  the 
schools. 

A  comprehensive  program  for  the  fintling  and  reporting  of  all  cases  of 
tuberculosis  ;  and  the  segregation  of  all  open  cases  not  under  the  care  of 
familv  physicians  ;  and  the  jirevention  of  the  ex])osure  of  open  cases  of  tuber- 
culosis to  children  under  1(1  \ears  of  age,  was  also  instituted  at  this  time 
in  C  hic;iL;o  li\-  Dr.  Robertson.  This  resulted  in  the  lowering  of  the  tubercu- 
losis (K-ath  rate  i;f  tlu'  city  to  such  an  extent  that  it  attr.acted  the  attention 
of  health  ofiicers  in  man\-  cities  in  the  Tnited  Slates,  and  health  from  for- 
eign countries  who  \isileil  C'hicago  to  stiuh  the  methods  of  tuberculosis  con- 
trol  followed  there. 

beginning  in  l'.M."i.  at  KO.d  per  loo.ddd  population,  the  death  nite  from 
tuberculosis  (all  forms)  dropped  year  b\-  \ear  to  ;s.:!  in  \'^'''i.  a  reduction 
of  "i  I  |ier  cent  in  se\en  years,  'Ihis  showed  wh.il  could  be  accomplished 
by  com])rehensi\(.'  and   \  igoroiis  elTorts  to  control   the  disease. 


HEALTH   CONDITIONS   AFTER    ll^TT  371 

A  health  survey  of  White  County  was  made  in  1 '.)]."').  under  the  auspices 
of  the  Illinois  State  Association  for  the  freventicm  of  Tuljercuhjsis.  and 
the  Illinois  State  Board  of  Health.  The  work  was  done  by  Dr.  I.  H.  Foster, 
inspector  tor  the  Board  of  Health,  and  Miss  Harriet  Fulmer,  R.  N.,  exten- 
sion secretary  of  the  Association  f(jr  the  Pre\-ention  of  Tuberculosis. 

The  tuberculosis  cases  and  deaths  from  the  disease  in  White  County  in 
lOl.j  are   shown  bv  the  spot   map.   reproduced   in    I<"isj;ure   '^'>. 

Three  progressive  steps  were  taken  by  the  State  in  the  campaign  against 
tuberculosis  in  IDlo.  The  one  was  an  order  making  tuberculosis  a  reportable 
disease,  the  second  the  promulgation  of  rules  and  regulations  for  the  control 
of  pulmonary  tuberculosis,  and  the  third  was  an  enactment  of  the  county 
sanitarium  law,  also  introduced  by  Senator  Glackin  of  Chicago. 

In  the  November  election  of  llUti,  Adams.  Champaign.  Morgan.  Mc- 
Lean. Ogle,  Livingston  and  LaSallc  Counties,  voted  to  buikl  sanatoria. 
At  the  next  regular  election  the  counties  of  Boone,  Bureau,  Christian,  Clark, 
Clay,  DeWitt,  Coles,  Crawford,  DeKalb,  Douglas,  Fulton,  Grundy,  Henry, 
Jackson,  Jeft'erson,  Kane,  Lee,  Logan  McDonough,  Macon,  Madison,  Mar- 
ion, Piatt,  Pike,  Randolph,  Scott,  Stephenson,  Tazewell,  Vermilion,  White- 
side, Will.  Winnebago,  and  Woodford  took  ailvantage  of  the  tuberculosis 
sanitarium  law. 

Since  the  Ori/cnnzaf inn  nf  flir  Stdic  DrjKutiiifiif  nf  Puhlic  llcditli. 

"\\'hen  the  State  Civil  Administrative  Code  was  passed  in  IIHT,  and  the 
State  Board  of  Health  was  abolished  and  the  State  Department  of  Public 
Health  created,  in  the  Department  a  division  of  tuberculosis  was  established 
as  a  sjiecial  unit.  The  assistant  director  of  the  Department,  Dr.  George 
T.  Palmer,  was  assigned  as  acting  chief  of  the  division,  a  clerk  and  steno- 
grapher were  employed  and  the  division  of  tuberculosis  began  to  take  an 
active  ])art  in  the  state-wide  anti-tuberculosis  campaign. 

(  )n  accoimt  of  shortage  of  nurses  for  tul)erculosis  and  other  health 
work,  the  State  Deiiartment  of  Pu1)lic  I  lealth,  the  State  Department  of 
Welfare,  and  the  Illinois  Tuberculosis  Assn-iation  as  it  was  now  called, 
established  a  school  for  public  health  ninses,  gi\ing  brief  l)Ut  comiirehensive 
courses  several  times  a  year. 

To  secure  a  more  definite  idea  of  the  extent  of  the  tuberculosis  jiroblem 
in  Illinois  the  division  of  tuberculosis  outlined  a  plan  of  sur\ey  to  be  em- 
plii\(.(l  by  nurses  and  others  engaged  in  this  work.  Through  this  plan  a 
large  numljcr  of  tuberculosis  surveys  were  made  in  \arious  localities  in  the 
State. 

Shortly  after  the  United  States  engaged  in  the  World  War,  there  was 
created  a  subcommittee  of  the  State  Council  of  Defense,  devoted  to  tubercu- 


WHITE  COUNTY,    ILLINOIS. 

/V-  2 J 052  -  /9/0  Census. 


•    L/W//70  Cases  of7udern//os/s-/S/S     a/7TJ^     y      j:     .  r  ■ 
■    Dea^fys- from  Tu^erca/os/s  /9/47/S  c^ses ma/f//?/i/ ^mm <j^/fys /;^ /c 


HEALTH   COXDITIONS  AFTER    18?  T  373 

losis.  of  which  the  assistant  director  of  the  State  Department  of  I'uhhc 
Heakh  was  made  chairman.  'J'his  suhcommittee  was  coorcHnated  with  the 
division  of  tnliercidnsis  nf  the  State  l)e]iarlment  of  I'nhHc  IleaUh.  and  w  itli 
the  IlHni.is  Tnljercnlosis  Association.  It  ceased  to  fnnctiim  after  the  .\rmis- 
tice  was  sitjned. 

(.)n  account  of  the  importance  of  exchiding  tuberculous  individuals  from 
military  service  and  the  necessity  for  greater  medical  knowledge  in  the  care 
of  returned  tuhercidous  soldiers,  the  State  Department  of  Public  Health,  in 
conjunction  with  the  Illinois  Tuberculosis  Association,  conducted  clinical 
conferences  on  the  diagnosis  and  treatment  of  tuberculosis,  utilizing  the  best 
known  teachers  of  this  sidjject  in  the  Middle  West.  Conferences  were  at- 
tended by  physicians  from  all  jjarts  of  the  State.  Special  tuberculosis  clin- 
ics were  also  given  before  county  medical  societies. 

To  meet  the  needs  of  returned  tuberctilous  soldiers,  who  on  account 
of  inade(|uate  facilities  for  care  of  the  tuberculous  in  Illinois,  were  subjected 
to  neglect,  a  working  agreement  was  entered  into  between  the  State  Depart- 
ment of  Public  Health,  the  American  Red  Cross,  and  the  Illinois  Tubercti- 
losis  Association,  whereby  the  Department  and  the  Association  provided  for 
scientific  examination  and  medical  direction  of  returned  soldiers. 

At  the  beginning  of  li)18,  the  War  Department  advised  the  State  De- 
partment of  Public  Health  of  the  return  of  about  1,T0()  tuberculous  soldiers. 
This  number  was  increased  to  1,800  at  the  time  of  signing  the  .\rmistice. 

It  was  fortunate  that  the  establishment  of  county  and  municipal  tuber- 
culosis sanatoria  was  continued  through  the  war  period,  for  these  sanatoria 
served  a  useful  purpose  in  hospitalizing  the  service  men  who  returned  af- 
flicted with  tuberculosis. 

I'larly  in  lit  I!.),  the  LaSalle  and  .McLean  county  sanitariums  were  o])ened. 
In  addition  to  Chicago,  the  cities  of  Rock  Island.  Peoria  and  Pockford  were 
maintaining  tuberculosis  sanatoria  at  that  time. 

The  .\dams  Countv  tul)erculosis  sanatorium  began  o];)eration  alter  the 
end  of  the  \'ear.  .\  small  sanatorium  w;is  in  operation  in  DeKalb  Count), 
and  iil;ins  were  being  made  fur  UKire  extensive  buildings.  Tazewell,  Mc- 
Donough,  Woodford,  and  Kane  tuljerculosis  sanatoria  were  under  process 
of  construction. 

The  tulierculosis  death  rate  in  the  State  in  Pi'i:>  was  Sl.S  jier  liH),000 
population,  and  tuberculosis  stood  liftli  fr(ini  the  top  of  the  list  of  causes  of 
death. 

Ouestionnaires  were  sent  in  I'.i'.^'i  to  all  private,  county  and  municipal 
tuberculosis  sanatoria  in  the  Slate  to  obtain  up-to-dale  data  fur  a  revised 
directory.  Stn-v(\s  weri-  m;ide  of  iul)crculosis  cases  on  record  in  the  coun- 
ties of  the  Stale  with  the  object  of  pmviding  befter  home  c:nv  and  In  protect 


3'i'4  iiicAi.rii  coxniTKiNs  aftiik  IS*? 

others  frcim  infcctinii.  'Ihr  suivcv>  slmwrd  that  iciL;ular  and  periodic  tuber- 
culosis clinics  wcic  in  dpcralion  in  IM  conniics  and  that  1  o  county  sanatoria 
with  1,3T5  l)cds  \\cic  in  operation. 

The  Mel  Idnout^h  and  Madison  county  tulierculosis  sanatoria  were 
ojK'ned  in   i:i".M). 

Tliree  ini]>orlant  hills  relating  to  the  control  of  tuljerculosis  were  enacted 
by  the  legislature  in  1 '.)".' "i. 

One  nia<U'  the  maximum  tax  for  numicipal  tuberculosis  sanatoria  two 
instead  of  one  and  mu-ihird  mills  on  the  dullar  of  assessed  valuation. 

The  >ecoiid  was  a  law  regulating  the  pasteurization  of  milk  and  requir- 
ing a  permit  from  the  State  Department  of  Public  Health. 

The  third  law  api)ropriated  -Isi.OOU.OOii  for  the  purpose  of  imiemnifying 
owners  of  tuberculous  cattle  destroyed  under  the  provisions  of  the  law  of 
1!)1!),  which  autliorizcs  the  slaughter  of  domestic  cattle  found  to  be  infected 
with  tuberculosis.  This  had  been  practiced  before  but  never  Ijefore  had  so 
much  been  appropriated  at  one  time. 

The  latter  was  the  so-called  "Tice  Mill"  which  ])rovided  for  the  tul)er- 
culin  testing  of  cattle,  the  establishment  of  accredited  herds,  and  for  the  en- 
rollment of  counties  under  the  county-accredited  plan,  under  which  it  is 
obligatory  for  the  remaining  herd  owners  to  test,  whenever  rnore  than 
seventy-live  per  cent  of  the  cattle  in  any  county  have  been  tested,  and  proper 
certitication  of  this  fact  has  been  made  to  the  county  authorities,  in  accord- 
ance with  the  provisions  of  the  law. 

Tuberculosis  eradication  among  dairy  cattle  had  progressed  very  rapid- 
ly, and  by  the  end  of  1926,  the  situation  was  approximately  as  follows: 
Sixty-five  counties  were  under  federal  and  State  supervision  for  the  eradi- 
cation of  bovine  tuberculosis;  21  counties  had  herds  T5  per  cent  free  from 
bovine  tuberculosis  ;  ;uid  one  county  was  IIH)  per  cent  free  from  bovine  tuljer- 
culosis. 

Miscellaneous  Ccmvnunicable  Diseases. 

The  comprehensive  sanitary  surveys  made  in  apitroximately  four  hun- 
dred cities  and  villages  duritig  the  years  1882-1885  indicate  in  a  general  way 
that  very  little  attention  was  given  by  local  authorities  in  these  municipali- 
ties at  that  period  to  control,  su]i])ress  or  jireyent  the  so-called  minor 
contagious  diseases  such  as  measles,  whoo|iing  cough,  chickenpox,  etc. 

The  statistical  data  available  for  that  early  period  are  given  in  the  spec- 
ial comments  under  I'ach  of  these  diseases  (ir  in  the  chart  accompanying  each. 

In  fact  the  data  mi  these  .so-called  mincir  diseases  are  very  fragmentary 
until  about  IIMI-.'.  In  all  sections  of  tlu'  ."^taie  exci-pt  Chicago  they  were  far 
from  com])lele  until  \ery  recent  years.  (  )nly  since  l!i"iO  have  the  statistical 
data  1)\-  moiuhs  been  made  accessible  in  tabular  t(n'in  Ijv  counties. 


HEALTH   COXDITIONS  AFTER    187  7 


3r:i 


Table  56. 
Cases  of  Cerebrospinal  Fever  Reported  in  Illinois. 


Year.                   Jan.     Feb. 

Mar. 

Apr.     May. 

June. 

July. 

Mxg.   Sept.    Oct. 

Nov. 

Dec. 

Total. 

1917 
1918 
1919 
1920 
1921 
1922 
1923 
1924 

12     1     14     1     2S     1     42 
4S     1    5S     1     69         62 
16     [     15         14         12 
31     1    33    1    28         12 
20     1    25     1     25         11 
19     ]     22     1    26         27 
15     1      8    1     25         17 
11     1      2     1      9     j      7 
9     !      9     1      S           3 
7     1      SI      7     1     11 

65 
33 
18 

14 
18 
15 
9 

4 
15 
32 

57 
19 
12 
13 
15 
15 
6 
4 
5 
8 
41 

61 
26 
14 

19 
6 

11 
5 

36         37 

14         16 

11  16 

12  15 
12         16 
11         11 
11    1      3 
11     1       8 

36 
8 
27 
16 
21 
6 
11 
9 
8 

29 
4 
22 
20 
18 
6 
11 
6 

a 

33 
12 
9 
9 
19 
14 
4 
2 
26 
14 

450 

3S9 
186 
210 
219 
178 
131 
81 
SO 

1926 

13 
20 

3         11 

8    ;    12 
...| 

117 

1 



1 

Table  57. 
De.'vths  from  Cerebrospinal  Fever  in  Illinois. 


Year. 

i  Jan. 

1 

Feb. 

Mar. 

Apr. 

May. 

1  June. 

July. 

.\ug. 

Sept. 

Oct. 

Kov. 

Dec. 

Total. 

1918 

i 
51 

47 

67 

S9 

46 

35 

^:^ 

37 

24 

39 

27 

33 

500 

1919 

30 

27 

36 

22 

23 

16 

30 

22 

16 

23 

18 

26 

239 

1920 

29 

29 
15 

23 
9 

22 
4 

17 
3 

19 
6 

21 
7 

21 
6 

18 
4 

18 
7 

18 

7 

13 
5 

248 

1921 

3 

76 

1922 

4 

3 

6 

10 

H 

6 

4 

2 

2 

2 

2 

1923 

8 

5 

9 

HI 

6 

1      * 

2 

7 



4 

4 

1921 

3 

? 

5 

8 

6 

3 

4 

2 

3 

2 

4 

1      1 

43 

1925 

1      3 

5 

9 

2 

9 

3 

1 

4 

5 

4 

4 

1       <' 

56 

1926   

1 

6 

5 

9 

6 

6 

» 

3 

3 

6 

3 

58 

Table  58.* 

Deaths  and  Death  Rates  from  Meningitis,  Cephalitis,  Cerebrosimnal 
Fener  a.m)  Encephalitis  in  Illinois. 


Rate  per 

lOO.OOO 

Year 

Xo 

.leatl 

^■ 

lopulation 

Year. 

I8fin 

701 

41.2 

1910  

1870 

1,975 

77.8 

1911    .... 

ISSIl 

872 

28.3 

1912   

1881 

2,863 

90.8 

1813   

1XS2 

2,310 

71.5 

1918  ----- 

1K83 

1.535 

46.4 

1919      --- 

1X,S1 

1.97! 

58.3 

1920  - 

18W 

2.1C6 

60.9 

1921   

1886 

2.276 

64,5 

1922  

190(1 

1.195 

31.0 

1923  - 

1907 

06S 

17.91 

1924 

19(18 

782 

14.28 

1925   -- 

1909 

744 

13.38 

ni\i 

of    diseases 

has 

been 

included 

becau 

<e    of    the    I 

tity 

of    an 

V   ii 

the   earlier 

part 

of 

th 

e   period 

■overed 

Rate  per 

100,000 

population. 


11.9 
10.8 
11.1 


5.99 
5.68 
4.62 


that    confused    the    ide 


3:(! 


m-.Ai.Tir  cnN-iMTUiNS  aftkr  187' 


llnw  prevalent  most  of  these  diseases  were  in  Illinois  prior  to  about 
11M;  can  only  be  guessed  at  from  circumstantial  evidence,  'i'bey  were  tirst 
nia<k'  re|«irtablc  to  the  State  Hoard  of  Health  in  ^'M'>.  .Machinery  for  col- 
Icclini;'  rc|ioris  with  any  satisfactory  dcj;;rec  of  completeness  was  not  estab- 
lished until  r.in.  Case  reports  from  l!)"il)  on  sj;ive  a  fair  conception  of 
prevalence  trends.  l'"rom  mortality  records  one  may  gather  some  idea  of 
epidemic  cycles  but  the  ratio  of  deaths  to  cases  has  doubtless  declined  in 
reference  to  several  diseases  so  that  the  actual  number  of  deaths  is  not  al- 
ways a  reliable  index  to  prevalence. 

'I'liere  follows  a  brief  mention  of  these  various  diseases  so  far  as  any 
interesting  facts  are  obtainable. 

C'KKi'-.iiiiospix.M.  Fkver. 

Long  before  i'^'i'i  cerebrospinal  fever  had  ceased  to  be  an  imjiortant 
cause  of  death  in  Illinois.  By  that  \ear  mortality  had  dropped  to  less  than 
1  per  100,00(1  while  evidence  pointed  toward  total  disappearance.  Fifty 
years  earlier,  as  shown  liv  the  graph  in  b^igure  'ia.  this  disease  was  one  to 
be  greatly  dreaded  and  a  frequent  cause  of  death. 


Figure  25. 


HEALTH   CONDITIOXS  AFTER   1ST7  3TT 

Prior  t(i  ]8<S0,  especially  in  the  census  returns,  many  acute  diseases  of 
thf  hrain  and  meninges,  were  classed  under  such  indefinite  headings  as  in- 
flammation of  the  lirain.  dropsy  of  the  brain,  convulsions,  meningitis,  both 
nonspecific  and  tubercular,  and  many  other  brain  affections  such  as  abscess 
and  tumor;  also  a  certain  number  of  cases  of  anemia  and  intoxications  with 
convulsions  or  coma  were  included  under  meningitis  and  similar  brain  af- 
fections. 

Tubercular  meningitis  was  first  recognized  as  an  etiologic  entity  in  the 
years  just  ])rior  to  the  first  great  epidemic  of  cerebrospinal  meningitis,  which 
began  in  1S7;.'.  During  this  epidemic  cerebrospinal  fever  began  to  lie  rccdg- 
nized  as  a  distinct  disease. 

The  next  great  epidemic  occurred  in  is.si -iss:!.  It  was  this  outbreak 
that  was  largely  responsible  for  the  high  death  rate  recorfled  from  this 
disease  in  Illinois  during  the  early  eighties,  although  it  cannot  be  assumed 
that  all  of  the  deaths  recorded  under  this  rubric  at  that  time  were  true 
cases  of  this  disease.  The  same  confusion  anil  uncertainty  in  diagnosis  still 
existed  due  in  part  onlv  to  unqualified  practitioners  of  medicine  but  largely 
to  the  fact  that  the  finer  and  later  bacteriologic  methods  of  diagnosis  had 
not  been  developed. 

Knowing  that  cerebrospinal  fever.  ])revailed  extensively  over  the  whole 
United  States  duriuL;  the  epicleniic  of  lSSl-s:i,  it  ma\-  be  assumed  that  a 
large  per  cent  of  deaths  attriliuted  to  this  cau>e  in  the  early  eighties  as 
shown  on  the  chart,  were  reallv  due  to  the  true   form  of  this  disease. 

'J"he  next  nation-wide  eijidemic  occurred  in  ISU.S-T.mhi.  This  manifested 
itself  in  Illinois  by  a  death  rate  of  a  little  over  3  per  IdO.iiiMi  population. 
By  this  time  the  disease  was  well  established  as  a  clinical  and  etiulngic  entity. 
The  rate  recorded  is  one  obtained  from  the  census  returns  and  is  therefore 
probably  not  very  accurate.  Nevertheless,  it  shriws  that  Illinois  was  swept 
by  the  epidemic  at  that  time. 

Another  outbreak  was  recorded  in  I  HI".'  and  .an  increased  incidence  wa-^ 
shown  beginning  about  1'.)".'."),  but  insignificant  in  ci)m|iarison  to  the  jireva- 
lence  <.f  the  disease  in  the  first  decade  of  this  .Ml  year  period. 

Diarrheal  Dise.ases. 

Nomenclature  for  diseases  of  the  intestinal  tract  was  so  thoroughly 
abused  that  it  is  difficult  to  arri\-e  at  any  satisfactory  conclusions  concerning 
the  prevalence  of  what  are  usually  referred  to  as  diarrheal  disorders.  In 
the  mortality  returns  for  1880,  for  example,  there  were  listed  cholera  in- 
fantum, cholera  morbus,  diarrhea,  dysentery,  enteritis  and  bowels  as  the  re- 
sponsible agents  for  1.(10(1  out  of  l.'i.on  fatalities  registered  from  all  causes. 
This  corresponded  to  a  rate  of  about  118  deaths  ])er   l()l),()(i()  population. 


3T8  TIKALTII   COXDiriO.NS  Al-'ll-K    1S77 

AnothiT  chu'  1(1  what  may  have  heen  the  case  is  found  in  the  high  fatal- 
ity rates  aninnt^  chihh-cn.  It  is  common  knowledge  that  intestinal  difticul- 
ties  constitute  cmc  df  the  greatest  hazards  to  child  life.  It  is  easy  to  believe 
therefore,  that  an  excessively  high  mortality  ann mg  children  is  evidence  of 
a  high  prevalence  of  <liarrheal  diseases.  There  were  lO.iHiS  deaths  among 
children  lf>s  than  one  year  old  and  lil,(i()T  less  than  five,  reported  in  ISSO. 
These  figures  amounted  to  twenty-four  and  forty-three  percent  respectively 
of  all  registered  mortality  in  that  year. 

Using  mortality  figures  found  under  the  same  nomenclature  referred  to 
above  it  is  found  that  the  incomplete  returns  for  the  years  ISSl  to  1886  in- 
clusive give  an  average  mortality  rate  of  iri.'i.K  per  lOO.OOo  pojjulation.  Stat- 
tistics  for  the  five  years  ended  with   r.f.'."i  give  an  average  mortality  rate  of 

Table  39. 
De.vtiis  and  Death   R.\tes  from   Diarrheal  Disea.ses  in   Illinois. 


Year. 

1860  

X.).  ileatlis. 
2,320 

Rate  per 

100,000 

population. 

128. 8 

1SS.3 

148. 

ISl.o 

107.7 

109.7 

110. 

106.5 

119.9 

Year. 

1905   

1906   

1907  

1908   

1909 

Xo.  ileatlis. 

4,552 
4,612 

4,S57 
5,224 
5,6S6 

Rate  per 

100.000 

population. 

87. 

86.8 

90. 

1880  

95.4 
102.3 

1881  

5,723 
3,478 
3,624 

111.8 

1882  

1911 

4,973 

86.5 

1883    

1912   -- 

1913   

1918 

1919  

1920   

1921 

1922   

1923  . 

1924  - 

1925  .- 

4.970 
5,520 

4,2S4 
2,993 
3,532 
3,250 
2,241 
2,369 
1,938 
2,208 

85.2 

1884 

93.2 

1885  

1886  - 

3,677 

67.4 

1S90 

46.4 
54. 

1900 

49.1 
33.4 

1902 

1903    

1904  

3,967 

4,296 

4,320 

79.5 
84.7 
93.9 

34.8 
2S.1 
31.1 

3o.3  from  diarrhea  and  enteritis.  This  classification  includes  practicall)-  all 
mortality  of  the  period  that  might  be  called  "diarrheal"  in  character. 

Still  another  evidence  that  diarrheal  diseases  were  highly  prevalent  dur- 
ing the  last  (|uarter  of  the  nineteenlh  century  is  the  fact  that  summer  was 
the  most  unhealthful  season  of  the  _\ear  then.  Year  after  year  the  great- 
est number  of  deaths  monthly  occurred  in  .\ugust  and  September.  Diseases 
of  the  inteslin;il  tr;ict  ;ire  ahva\s  prune  to  reach  highest  prevalence  in  the 
warm  weather. 

Ini])r(ivenu-nt  in  ihe  sanitary  (luality  of  milk  supplies  and  especiallv  the 
introdiutiim  and  extension  of  pasteurizatinn.  the  development  of  refriger- 
ation, the  ])virilic;uiiin  of  water  supplies,  the  advancement  in  personal  hy- 
gienic  habits,   the   screening  against   flies   and   the  general   improvement   in 


HEALTH   COXDITIOXS   AFTER    187' 


379 


economic  conditions  have  all  been  important  factors  in  bringing  about  more 
favorable  mortality  rates  from  diarrheal  disorders.     The  substitution  of  the 


Fig.  26.  Deaths  due  to  diarrhea,  dysentery,  cholera  infantum,  cholero  mor- 
bus, enteritis,  teething  and  bowel  complaint  are  included  in  the  statistics 
illustrated  in  this  figure. 

automobile  for  the  horse,  a  change  that  roblied  the  hnuse  fly  of  his  most  pro- 
lific breeding  ])lace,  doubtless  was  an  important  factur  in  preventing  the 
spread  of  diarrhea. 

IxFANTiLE  Paralysis. 

Infantile  paral)'sis  first  appeared  on  the  vital  statistic  records  of  Illinois 
in  1912.  In  that  \ear  -"iS  deaths  were  charged  against  it.  This  does  not 
imply  that  the  infection  never  existed  or  that  it  never  proved  fatal  in  the 
State  prior  to  that  time.  Public  attention  however  had  never  been  specifical- 
ly called  to  the  fact  that  it  was  an  infectious  disease  and  doubtless  its  jires- 
ence  in  the  early  acute  .stage  was  often  overlooked  by  physicians.  It  is  alto- 
gether likely  that  cases  developed  from  time  to  time  without  ever  assuming 
alarming  epidemic  ijvoportions  for  the  crippling  ;ifter  effects  of  this  disease 
were  frequently  seen. 

After  19i;i  jjoliomyelitis  went  down  into  recorded  obliviim  with  the  con- 
fusion that  prevailed  in  Illinois  vital  statistics  until  191(i.      In  that  \ear  over 


■i'^iO  IIICAI.TH    CONDITIONS  AFTMK    IST" 

ri, 000  cases  wtTc  rL-])ortc(l  in  Xrw  ^'ork  and  about  l.niX)  in  Illinois.  A  gen- 
eral panic  prevailed.  In  \'J\:  a  reL-urrenee  of  the  epidemic  dceurred  result- 
in.c^  in  S3()  deaths.  Since  that  time  mortalit\-  fidni  infantile  parahsis  has 
\-aried  from  •.'■")  in  ll)"2(l,  ihe  Idwest  to  1-Ml  in   l!)-*l. 

1  he  crippling  etiects  nf  the  disease  created  a  grave  problem  in  curative 
medicine  that  recpn'red  the  services  of  specially  trained  physicians.  So  great 
was  public  demand  for  this  type  of  work  that  the  State  Board  of  Health, 
later  the  State  Department  of  Public  Health,  established  cHnics  at  various 
piiints  in  the  State  in  1916  for  the  benefit  of  victims  of  poliomyelitis.  New 
and  old  patients  continued  to  demand  this  type  of  service  so  that  it  remained 
a  fimction  of  the  State  Dei)artnient  of  Public  Health  until    l'.i-.'.">   when  the 

Table  (;ii. 
De.\tiis  and  Death  Rates  from  ruLioMVELiTis  in  Illinois. 


Rate  per 

Rate  per 

100,000 

100,000 

Su.  .leatlis. 

population. 

Year. 

Xo. 

deaths. 

population. 

58 

.99 

1922  

52 

0.8 

236 

3.8 

1923  

48 

0.7 

113 

1..S 

1924  

26 

0.4 

73 

1.2 

1925  

41 

.57 

57 

.9 

1926  

23 

.34 

150 

2.3 

Year. 

1912 
1917 
191S 
1919 
1920 
1921 


curative  clinical  work  was  taken  over  liv  the  Illinois  Society  for  Crippled 
Children. 

In  the  meantime  poliomyelitis  continued  to  occur  from  year  to  year  in 
cyclic  waves  that  characterize  almost  every  communicable  infection.  Sub- 
sequent to  191(5  and  1917  the  outbreaks  were  less  extensive  in  magnitude  and 
the  disease  appeared  to  lie  generallv  mibler  in  character,  the  percentage  of 
f.atal  cases  being  lower. 

Poliomyelitis  is  another  of  the  warm  weather  infections.  Case  reports 
for  September  are  usually  greater  in  numlier  than  for  any  other  month.  It 
rises  quickly  to  its  maximum  incidence  once  it  begins  to  spread.  Indeed  the 
prt'v.ilence  in  .Sejitember  is  fre<piently  double  that  in  .\ugust. 

Malart.\. 

Few  diseases  demonstrate  more  fully  than  malaria  the  power  man  can 
acquire  over  comniunicable  infections.  I'rdni  ,i  \eritable  plague  that  few 
inhabitants  of  the  Slate  escaped  and  of  which  many  died  in  the  early  days, 
malaria  has  come  to  be  one  of  the  most  insignificant  causes  of  mortality  in 
lllniciis.  Registered  deaths  per  joo.nno  population  fell  from  (ir,.9  in  1S(i(l, 
when  mortality  reports  were  very  iiicunqilete,  to  less  than  O.ii  in   19'Jii. 


HEALTH    COXniTIOXS  AFTER    1S7T 


381 


Even  liefore  Ross  discovered  in  1S!I7  tliat  malaria  is  sjiread  fmni  one 
person  to  another  only  through  the  anopheles  nmsiiuitd  the  prevalence  of 
and  mortality  from  malaria  was  on  the  wane  in  Illinois.  \'ery  early  I'cople 
recognized  that  drainage  was  important  as  a  preventive  of  malaria  hut  drain- 
age was  promoted  more  for  agricultural  than  for  health  reasons.  Thus  the 
decline  of  malaria  was  incidental  tn  the  Imilding  up  nf  cities  and  the  develop- 
ment of  agricultural  pursuits  rather  than  the  result  of  a  conscious  attack  on 
the  disease. 


66 

35 

oii-^ 

1 

1  !i 

1 '    ! ' 

Hi    11      1        ...          _        lliiil 

;  1  1  1  1 

4t 

1 

riALAWA 

n  iLLimi 

"■' 

I 

j-^=j 

'    1 1 

!    ! !  j  i  '  ■  1  1  I  I  ■ 

1 

1  ! 

'           1  '  '       '1 

^  'Vi 

1 

J~ 

1 1 ii  1  F  1  >  '  .       .  -  '  ■      ' 

T      T 

1 

1    1  ■ 

lAAD-iqPA 

.  -   "^l 'X 

30 

E 

p 

i  ^^ 
i" 

in 

r 

f 

,    ,1       ,1 

1      1                 ■      ■ 

1     1 

il"X 

1  1    ill    '    II 

i 

1 

1 

_i_  '     T 

U-   t 

1  1  ' 

1 1 ! 

1 

! 

1      IP 

1 

1    I    M      1 

i 

i  1  i :    i  i    ill! 

1     j 

1    1  !;  11 

RTir+ "^ 

;i 1 |l 1   1   1 1   i 

St+"- 

li' 

I    j      |!|| 

^rti'i 

1     M  ' 

j  1 

j       1    1  1 

; 

1      1    '  1  '  F  h  1 

.:iL_:_: 

ii  iii'i 

1 1 

jl 

1  j    \\j\\ 

1 ' ' 

1 

■■ 

1  ,  1  1  ;  1  1 

1 

1 

^H~ 

1       '      1  1 1 

'     '  '  '     1 

+u 

^H 

1 '  i       '      1 

'''ill 

T+  ill 

^H 

til    '    1      ;  1 

'  '     '            '  1  '  '  1  i 

I 

,< 

^H~ 

til  ;'     1 

■  ■  ■  '     '     '  I     ■  ' 

I  T 

'q 

^H 

'  ■  ■              '  1       ■ 

|0     5 

T  T 

^H 

i_i  '  '    r      ■  '  h  ' 

1 

T  T 

SH-' 

J 

■  1  '  '    M  '  '    1    1 

1 

i~  \ 

:^^B; 

■ 

B  '  '  '  '      1  1  1  '  M  1 

1  1 

— ttt 

.    .       ■ 

Tiafl^ 

2i:±::::"" 

I    ;±i 

_^Hii 

1    ■ 

IIBi^»*fTTi-rT 

i     i     i     i     i     i     i      i     i      i      1     8      i      i 

Figure 


.\ftcr  it  Ijecame  known  that  nio,-,(|uit(ies  are  the  carriers  of  malaria,  pre- 
veiitixe  work  was  directed  against  that  insect.  Undertakings  of  this  kind 
have  been  confined  largely  to  the  extreme  southern  counties  of  the  State. 
There  alone  does  malaria  still  exist  to  any  significant  extent.  Elsewhere 
drainage  destroyed  the  breeding  places  of  the  malaria-bearing  mos(|uito  and 
with  his  disappearance  the  disease  vanished. 

In  lillG  the  chief  sanitary  engineer  of  the  .Stale  Department  of  Public 
Health  called  attention  in  an  article  in  llcaltit  Sews  to  the  heavv  economic 
losses  caused  bv  malaria  in  -.duihern  llliudis.     No  systematic  malaria-preven- 


382 


IlKALTll    COXniTlOXS  AFTI'.K    1S7T 


'I'able  C>\. 
Cases  of  Malaria  Reported  in  Illinois. 


Year.            .I.in. 

Feb. 

Mar. 

Apr. 

May. 

June. 

.Iw!y.  1  Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

Total. 

1917  

60 

81 

30 

49 

53 

121 

162 
2 

102 
1 

121 
3 

11 


89 

1,510 

2.389 

1919 

18 

20 

55 

97 

2 

1 

417 

294 

265 

170 

97 

63 

1,499 

1920 

59 

112 

84 

114 

142 

194 

171 

279 

117 

132 

87 

123 

1,614 

1921 

80 

14 

82 

44 

68 

138 

257 

148 

129 

66 

63 

37 

1,156 

1922 

50 

60 

22 

30 

60 

54 

43 

78 

61 

11 

22 

9 

500 

1923 

3 

3 

26 

6 

4 

5 

11 

14 

10 

2 

4 

3 

91 

1924 

1 

2 

1 

I 

4 

12 

11 

13 

3 

4 

6 

58 

1925 

5 

18 

2 

12 

8 

20 

6 

6 

2 

1 

34 

114 

1926 

7 

5 

4 

8 

6 

8 

7 

15 

10 

5 

11 

86 

1927 

5 

1 

1 

9 

16 

4 

U 





1             i 

Table  V>->. 
Deaths  from  Malari.\  in  Illinois. 


Year. 

Jan. 

Feb. 

Mar. 

Apr. 

Ma). 

June. 

July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

Total 

1918 

3 

4 

3 

6 

8 

7 

12 

14 

11 

8 

2 

3 

81 

1919 

4 

2 

8 

4 

2 

6 

15 

10 

9 

17 

6 

6 

89 

1920 

6 

2 

3 

3 

4 

8 

14 

8 

11 

8 

2 

76 

1921 

4 

5 

3 

3 

1 

5 

12 

14 

10 

15 

3 

3 

78 

1922 

3 

1 

2 

3 

1 

5 

S 

7 

9 

9 

8 

4 

60 

1923 

7 

4 

3 

4 

5 

3 

9 

4 

9 

5 

2 

4 

59 

1924 

4 

1 

4 

5 

6 

6 

3 

16 

11. 

6 

2 

3 

67 

1925 

2 

2 

1 

2 

3 

10 

9 

9 

10 

4 

4 

6 

62 

1926 

1 

1 

2 

2 

4 

1 

8 

7 

6 

' 

3 

0 

42 

1S60 

1870 

1880 
1881 
1882 
1883 
1884 
1885 
1886 

1890 

1900 

1902 
1903 
1904 
1905 


Table  G3. 
Deaths  and  De.\tii  Rates  from  Malaria  in  Illinois. 


1906 
1907 
1908 
1909 
1910 
1911 
1912 
1913 

1917 
1918 
1919 
1920 
1921 
1922 
1923 
1924 
1925 
1926 


deaths. 

Rate  per 

100,000 

population. 

1.146 

66.9 

9.030 

35.5 

1,114 

36.1 

23.8 
11.3 
11.3 


19.1 
10.3 


Rate  per 

100.000 

populalion. 


HEALTH   CON'DITIOXS  AFTER   ISTT  383 

tion  \v(irk  by  mosquito  eradication  was  undertaken,  however,  until  li)22,  but 
in  thf  meantime  the  matter  was  given  consideration  by  the  Southern  Illinois 
Medical  Society,  and  as  the  result  of  a  resolution  of  that  society,  studies  of 
mosquito-breeding  places  and  the  types  of  mosquitoes  prevalent  in  some 
southern  Illinois  communities  were  made  b_\'  entomologists  of  the  State  Nat- 
ural History  Survey. 

Proposed  and  recommended  by  the  State  Department  of  Public  Health, 
sponsored  by  the  Lion's  Club  of  Carbondale  and  receiving  financial  assistance 
from  that  club,  the  International  Health  Board  and  the  Illinois  Central  Rail- 
road, and  directed  by  the  sanitary  engineering  division  of  the  State  Depart- 
ment of  Public  Health,  Carbondale  carried  cm  systematic  mosquito-control 
work  for  the  season  of  1922,  and  for  the  first  time  in  history  of  the  city  en- 
joyed practically  complete  relief  from  the  pestiferous  insects.  The  results 
from  the  standpoint  of  reduction  in  malaria  cases  were  equallv  gratifying. 
\'ital  statistics  and  house-to-house  canvasses  had  shown  that  prior  to  1!)22 
the  city  suffered  an  average  of  over  250  cases  of  malaria  a  year  (267  during 
11121  ).  Following  the  close  of  the  mosquito-control  work  for  11122  it  was 
found  by  a  house-to-house  canvass  that  onlv  1  i)  cases  of  malaria  had  occurred 
during  that  year  in  the  entire  citv. 

This  was  the  beginning  of  mosquito-malaria  control  work  in  snuthern 
Illinois  which  has  continued  at  Carbondale  and  extended  into  half  a  dozen 
other  counties  with  increasingly  satisfactory  results. 

During  the  first  fifty  years  of  the  existence  of  State  public  health  service 
in  Illinois  medical  research  workers  discovered  the  causative  organism  of 
malaria,  found  out  how  the  disease  is  spread  and  prescribed  very  positive 
methods  for  its  prevention.  Thus  so  far  as  practical  possibilities  are  con- 
cerned it  may  be  said  that  malaria  was  cunqjletely  conquered  during  this 
[leriod. 

^Ieasles;. 

Measles  was  very  generally  ignored  in  reports  concerning  epidemic  con- 
ditions in  Illinois  during  the  last  quarter  of  the  nineteenth  century.  It  was 
included  in  a  list  of  diseases  for  which  epidemic  information  was  requested 
in  the  sanitary  surveys  of  1882-188.5  but  practically  none  of  the  local  re- 
ports mentioned  it.  Account  was  given  of  outbreaks  of  typhoid  fever,  chol- 
era, diphtheria  and  scarlet  fever  but  never  a  word  about  measles.  Evidentlv 
it  was  regarded  either  as  too  common  or  too  insignificant  to  mention.  To  lie 
sure  it  appeared  in  the  mortality  tables  where  these  were  supplied  but  withnut 
comment. 

In  the  general  mortality  statistics  available  for  Illinois,  measles  is  credit- 
ed with  10!)  deaths  in  1860  and  T02  in  1870.  These  figures  give  rates  of  6.3 
and  2;.()  per  1(10.000  population  for  the  two  years  respeclivelv.     For  the  six 


384 


IIKALTII   COXDITIOXS  AFTICR    1877 


years  of  ISSd-lSS,")  the  avcrasix-  annual  nidrtalily  rate,  as  n-pnrtc-d  in  the  sta- 
tistics which  were  regarded  at  the  lime  as  alxjul  III  per  cent  ineoniplele.  was 
i;3.5  per  TOO.OOO  people. 

Measles  is  distinctly  seasonal  in  character.  More  cases  occur  during  the 
three  months  of  March.  Ai^ril  and  May  than  during  all  the  rest  of  the  year. 
September  is  ordinarily  the  month  of  lightest  prevalence  in  Illinois.  The 
number  of  deaths  per  100  eases,  however,  is  greatest  when  the  prevalence  is 
least. 


Figure  2S. 

Measles  also  travels  in  epidemic  c\cles.  Thns  every  three  or  four  years 
there  are  general  outbreaks  of  major  proportions.  This  e.x]ierience  is  gen- 
eral. It  is  attributed  to  the  probable  fact  that  practically  all  susceptible 
persons  get  the  disease  during  the  big  epidemic  years  and  another  wide- 
spread outbreak  must  necessarily  await  a  new  croj)  of  susce])tible  children. 

.\lthinigli  verv  little  ad\aiu-emenl  in  knowledge  concerning  measles 
took  place  imlil  the  second  decade  of  the  twentieth  century,  progress  in 
medical  science  generallv  was  very  rapid  toward  the  close  ot  the  nineteenth 
century  and  this  imiirovemeiit  probably  explains  wli\-  the  a\erage  yearly 
death  rate    from   measles   was   only   .'i.-.'    for  the   six   year   period  ended  with 


HEALTH   CONDITIONS  AFTER   1877 


385 


Table  64. 


Cases 

OF    M 

EASLES  Reported  in 

Illinois. 

Year. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dee. 

Total. 

1917 

4,959 

6,483 

11,106 

10,534 

9,415 

4,255 

1,331 

312 

189 

122 

389 

417 

49,512 

1918 

1,150 

939 

1,237 

1,278 

1,501 

641 

273 

121 

56 

141 

67 

IVl 

7,575 

1919 

711 

1,073 

2,453 

5,754 

5,204 

3,142 

1,110 

255 

118 

342 

706 

1,727 

22,594 

1920 

4,366 

4,610 

4,982 

5,343 

5,542 

4,434 

1,573 

542 

233 

510 

1,280 

1,985 

35,400 

1921 

3,932 

4,527 

5,911 

5,894 

4,854 

2,435 

531 

129 

85 

164 

271 

560 

29,293 

1922 

918 

1,340 

2,167 

2,658 

3,285 

2,744 

1,182 

373 

141 

205 

606 

921 

16,540 

1923 

2,154 

4,011 

6,604 

10,345 

12,055 

6.320 

1,420 

306 

125 

363 

1,053 

1,953 

46,709 

1924 

2,475 

2,296 

2,659 

3,606 

3,825 

2,693 

926 

205 

120 

181 

343 

815 

20,144 

1925 

1,575 

2,664 

4,615 

5,985 

6,237 

4,010 

982 

169 

151 

273 

682 

868 

28,211 

1926 

1,825 

3,337 

4,514 

4,299 

5,095 

4,813 

1,980 

499 

236 

615 

1,368 

2,930 

31,511 

1927 

6,041 

8,469 

11,126 

7.622 

4,562 

2,084 

562 

1 

Table  65. 
Deaths  from  Measles  in  Illinois. 


Year. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

Total. 

1918 

22 
12 

22 

29 

42 
30 

60 
49 

74 
70 

30 

37 

14 
27 

6 

14 

5 
5 

17 
5 

12 
6 

13 
22 

317 

1919 

306 

1920 

47 

112 

72 

59 

59 

37 

22 

9 

4 

15 

25 

35 

496 

1921 

33 

47 

XO 

49 

50 

20 

12 

3 

3 

2 

4 

6 

309 

1922 

10 

13 

27 

30 

30 

26 

21 

9 

9 

6 

13 

12 

206 

1923 

24 

29 

79 

116 

165 

87 

31 

20 

3 

9 

2 

11 

576 

1924 

19 

25 

39 

54 

32 

26 

9 

7 

1 

1 

4 

11 

228 

1925 

11 

19 

36 

28 

52 

25 

13 

7 

4 

7 

3 

12 

217 

1926 

22 

28 

50 

78 

68 

33 

16 

11 

5 

2 

16 

17 

346 

Table  66. 
Deaths  and  Death  Rates  from  Measles  in  Illinois. 


Rate  per 

Rate  per 

100,000 

100,000 

Year. 

No.  deaths. 

poiiulatiuTi. 

Year. 

No.  deaths. 

population. 

1860  

109 

6.3 

1907  

413 

7.6 

1908  

336 

6.1 

1870  

702 

27.6 

1909  - 

1910  

385 
549 

6.9 

9.7 

1880  - 

603 

19.5 

1911 

325 

5.6 

1881 

625 

19.4 

1912 

191 

3.2 

1882  . 

451 

13.9 

1913  . 

63S 

10.7 

1883 

148 

4.4 

1914  

217 

3.6 

18S4 

629 

18.6 

1915    ...- 

286 

4  6 

191 

5.5 

4.6 

1917  - 

766 

12.3 

1890  . 

314 

8.2 

1918  .  . 

1919  -. 

317 
306 

5.6 
4.8 

1902 

180 

3.6 

1922   - 

206 

3.1 

1903 

593 

11.7 

1923  - 

576 

S.5 

1904 

393 

7.6 

1924 

228 

3.3 

1905 

340 

6.5 

1925   . 

217 

3.0 

1906 

230 

4.3 

1926   

346 

4.8 

386  }ii-:alth  conditions  aftek  1877 

!!»()■;.  l*'oi-  the  six  \(.ars  ciulcd  with  192G  a  still  more  favorahlc  rate,  an 
average  of  1.1,  prevailed.  Better  medical  care  of  patients  ciiu|)led  with 
better  public  health  service  are  the  only  two  factors  to  which  the  improve- 
ment mav  reasonably  be  attributed. 

While  mitliing  has  transpired  that  jjrovides  mankind  with  means  tor 
preventing  and  controlling  measles  on  a  large  scale,  research  work  charged 
with  hoiieful  premise  has  been  done.  In  1914  Hermann  suggested  the  ac- 
tive immunization  of  infants  by  inoculating  the  nasal  mucosa  with  the 
fresh  swabbings  of  the  nasal  mucus  of  patients  just  coming  down  with 
measles.  The  purpose  was  to  introduce  the  virus  at  a  time  when  the  infant 
was  still  carrying  a  certain  degree  of  inherited  immunity,  .\lthough  he 
apparently  had  good  success  with  the  method  on  seventy-five  children  so 
treated,  it  has  never  been  considered  practical  for  general  use. 

In  1918  Nicolle  and  Conseil  first  reported  favorable  results  with  the 
blood  serum  of  convalescent  measles  patients.  Such  serum  given  subcu- 
taneously  or  intramuscularly  in  amounts  of  5  cc  to  10  cc  as  soon  as  possible 
after  exposure  is  quite  effective  in  preventing  the  disease.  Passive 
immunity  is  established  for  three  to  six  weeks.  In  some  cities  ettorts  have 
been  made  to  collect  a  supply  of  convalescent  serum  taken  usually  five  or 
more  days  after  defervescence  of  the  fever.  Since  at  best  such  supplies  are 
limited,  some  attempts  have  been  made  to  use  blood  serum  or  whole  blood 
of  adults  who  have  had  the  disease  some  years  before.  Much  larger 
amotmts  must  of  course  be  used  and  the  results  have  not  been  so  uniform. 

In  1921  Zingher  recommended  the  production  of  active  immunity  by 
delaying  administration  of  convalescent  serum  till  the  fifth  to  the  eighth 
day  from  time  of  exposure.  Symptoms  of  the  disease  arc  nut  jire vented 
but  the  attack  is  very  mild  and  the  immunity  established  is  permanent. 
W  hen  the  serum  is  delayed  till  symptoms  appear,  no  beneficial  results  are 
obtained  even  with  large  amounts. 

In  1926  Tunnicliff  and  Hoyne  produced  a  serum  in  goats  by  repeated 
inoculation  of  Tunniclifif's  green  producing  diplococcus.  The  goat  serum 
is  ap])arently  as  efficacious  as  human  convalescent  serum  in  preventing 
measles  and  has  the  added  advantage  of  unlimited  supply.  Degkwitz  in 
Germanv  has  used  sheep  instead  of  goats,  injecting  them  with  the  Berkfeld 
filtrations  of  nasal  secretions  and  simtum  of  measles  patients. 

The  ])re\ention  of  measles  by  immune  serum  or  the  production  of  per- 
manent immunity  b}-  a  mild  attack  have  been  demonstrated  as  important 
factors  in  measles  control.  For  the  treatment  of  the  established  disease 
no  curati\e  agent  has  been  discovered. 


HEALTH    COXniTIOXS  AFTER    18TT  387 


Pneumonia. 


Pneumonia  was  prohahlv  nioix-  prevalent  fifty  years  ago  than  is  indi- 
cated by  the  1880  rate  of  ll'ir!  per  100,000  inhabitants.  There  was  consid- 
erable confusion  at  that  time  in  classification  of  deaths  from  the  disease  be- 
cause of  such  nomenclature  as  typhoid-pneumonia  and  typhoid-malaria. 

While  the  1890  rate  of  1"2S.;)  seems  to  indicate  some  progress,  we 
note  that  ten  years  later  (11)00)  the  rate  of  113.9  was  higher  than  in  either 
1880  or  1890. 

.-\gain  the  pneumonia  rate  in  I'.Mo  was  higher  than  ever  before  recorded 
as  far  as  available  recrrds  bear  evidence.  In  fact,  tlie  1910  rate  is  the  high- 
est ever  recorded  in  Illinois  with  the  exception  of  that  for  191S,  the  great 
influenza  }'ear. 

It  is  of  passing  interest  to  note  that  never  in  the  historv  of  Illinois 
was  the  recorded  pneumonia  death  rate  under  lOK  [ler  UIO.OIIO  of  i)o]Hilatinn 
prior  to  1921.  Since  19'^0  the  a\erage  annual  death  rate  from  pneumonia 
has  been  iSi.5.  and  only  once  in  the  si.x  years  ended  with  l't2(i  did  the  rate 
reach  imi.  The  excejrtion  was  192:5  when  the  rate  was  1(18.8.  Whether  we 
can  say  that  we  have  finally  reached  the  point  when  we  are  making  ])erma- 
nent  ]irogress  against  this  major  agent  of  death,  the  future  must  determine. 
The  rather  elongated  period  of  waning  mortalitv  at  least  lends  encourage- 
nunt  to  hope.  New  [jrocedures  employed  against  pneumonia  only  since  1913 
and  principally  since  l!''2u  include  t\ping  of  the  causative  organism,  the  use 
of  vaccines  and  sera  and  quarantine. 

Tjfpiiiff. 

Var  many  years  the  ]irobIem  nf  pneumnnia  wa^  ci:implicated  1)\-  the 
fact  that  organisms  indistinguishable  frcmi  virulent  pneumococci  were  found 
in  the  months  of  normal  persons.  In  1!M:!  wurkers  at  the  Rockefeller  In- 
stitute for  Medical  Research  in  New  York  found  that  all  pneumococci  could 
be  divided  into  four  groups,  types  I.  11.  Ill  and  I\".  This  wa.s  of  tremendous 
assistance  not  onl\-  in  stimulating  the  use  of  six'cific  antiserums  in  established 
cases  of  ])neumiinia.  but  of  soKing  prubknis  (jf  epidemidlogv  and  control 
(  f  the  disease. 

The  determination  of  ]ineumococcus  lyjies  was  \ery  [lojiular  during  the 
])eri(i(l  r.ill  to  1M2(I,  but  fell  off  so  that  it  was  almost  unused  in  ci\il  life 
after  that.  The  reason  for  this  was  the  fact  that  the  physician  could  do 
only  a  very  little  more  for  the  patient  if  the  t>])e  was  known  and  the  pro- 
cess was  considered  a  useless  e.xjjense.  In  1 '.)■.'.")  the  State  Department  of 
Public  Health  jjronuilgated  rules  and  regulaticjns  for  the  control  of  pneu- 
niduia  \\hereb\-  all  cases  should  be  "typed"  where  facilities  for  such  a  ]iro- 
cedure  were  available,  and  release  from  (|uaranline  should  be  allowed  onlv 


388 


ili'.Al.ril    CO.NDITIDNS  AFTKK    IS"  I 


Tabic  Cr. 
Casks  ov  Pneumonia  Reported  in  Illinois. 


Year. 

Jan. 

Feb. 

Mar. 

AP... 

May. 
612 

June. 

July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec.   1  Total. 

1 

1918 

602 

560 

1,242 

1,409 

163 

142 

68 

225 

10,375 

2,274 

2,596  1  20,298 

1919 

1,160 

820 

890 

600 

562 

355 

308 

185 

233 

451 

601 

1,275  1    7,440 

1920 

7,012 

4,049 

1,655 

1,066 

936 

485 

282 

215 

266 

335 

604 

980  1  17,885 

1921 

1,568 

1,222 

1,345 

992 

738 

429 

319 

305 

334 

614 

541 

824  1     9,231 

1922 

1,250 

2,629 

2,942 

1,621 

1,113 

548 

433 

820 

448 

736 

989 

1,659  1  15,189 

1923 

2,687 

3,508 

3,205 

2,439 

1,497 

718 

388 

330 

471 

814 

1,012 

1,239  1  18,308 

1924 

1,713 

1,798 

2,048 

1,643 

1,217 

738 

815 

822 

559 

677 

747 

1,440  1  14,217 

192o 

1,715 

1,681 

2,100 

1,718 

1,228 

767 

451 

380 

413 

687 

1,031 

3,044  1  15,215 

1926 

1,819 

2,028 

4,208 

1,961 

1,470 

1,223 

897 

531 

477 

684 

987 

1,344  1  17,629 

1,787 

1,515 

1,802 

1,609 

1,240 

959 

418 

i 

1 

Table  68. 
Deaths  from  Pneumonia  in  Illinois. 


Year. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

July. 

Aug. 

Sept. 

Oct. 

Kov. 

Dee. 

Total. 

1918 

984 

902 

1,181 

1,348 

683 

232 

185 

171 

453 

5,197 

1,571 

1,548 

14,455 

1919 

1,235 

1,027 

1,192 

697 

453 

268 

199 

158 

190 

278 

461 

Vb/ 

6,915 

1920 

2,218 

2,169 

893 

678 

583. 

267 

179 

171 

177 

273 

479 

643 

8,730 

1921 

857 

743 

691 

500 

389 

196 

178 

171 

195 

319 

432 

545 

5,216 

1922 

758 

782 

1,053 

712 

482 

242 

179 

171 

195 

357 

471 

740 

6,142 

1923 

1,105 

1,301 

1,02B 

798 

589 

278 

212 

186 

230 

315 

469 

558 

1924 

764 

748 

812 

699 

459 

322 

182 

150 

231 

323 

385 

655 

5,730 

1925 

792 

763 

906 

630 

488 

290 

198 

188 

196 

326 

560 

573 

5,900 

1926 

780 

742 

1,473 

824 

540 

295 

194 

161 

206 

295 

460 

657 

6,627 

Table  69. 
Deaths  and  Death  Rates  from  Pneumonia  in  Illinois. 


Rate  per 

Rate  per 

100,000 

100,000 

Y'ear. 

No.  deaths. 

population. 

Year. 

No.  deaths. 

poitulation. 

1860  .-  . 

1,357 

79.2 

1905  

5,877 

112.3 

2,8S2 

113.4 

1906 

6,136 

115.5 

1907  

7,386 

136.9 

4,378 

142.2 

6,008 

109.7 

1880  

1909 

7,327 

131.8 

3,723 

118. 
92.7 

1910  

1911  . 

8,938 

S,06S 

158.5 

1882  

2,994 

140.4 

1883  

2.51S 

76.2 

1912  . 

8.141 

139.5 

1884  ..- 

2.671 

79. 

1913  - 

S.237 

139.1 

1885 

2.764 
3,438 

80. 
97.4 

1918  . 

1919  . 

14.445 
6.915 

247. 

107.3 

1890  

1,912 

12S.3 

1920  . 

S,730 

133.7 

1921  . 

5,216 

78.8 

1900  

6,492 

143.9 

1922 

6,142 

91.6 

1923 

7.067 

104.1 

1902  

6,888 

138.1 

1924 

5,730 

83.3 

1903  

6,830 

134.7 

1925 

5,900 

1904  

6,887 

133.7 

1926  

6,627 

92.5 

HEALTH   COXDITIOXS  AFTER   187T 


389 


upon  the  absence  of  imeumococci  of  that  type  from  the  throat  of  the  patient. 
Standard  laboratory  methods  were  ch-awn  up  for  the  use  of  private  laliora- 
tiiries,  1)ut  Httle  demand  has  come  from  the  i)hysicians  for  aid  in  this  con- 
nection. 

Vaccines. 

The  jirevention  of  pneumonia  by  prophylactic  \accinatinn  with  killed 
cultures  of  the  organisms  was  placed  upon  a  practical  Ijasis  with  the  dis- 
covery of  the  various  types  of  pneumococci.     During  the  World  War  and 


Pig.  29.    For  the  years  prior  to  1900  the  death  figures  used  in  this  illustra- 
tion included  pneumonia,  influenza,  pleurisy  and  broncliitis. 

immediately  folldwing  the  value  (  f  the  process  was  definitelv  established. 
It  is  recommended  for  those  people  who  are  especially  susceptible  to  pneu- 
monia because  of  age,  undue  exposure  or  other  causes.  Since  immunity  will 
last  only  about  eight  months,  the  time  nf  choice  for  administration  is  at 
the  beginning  of  the  pneumonia  season  eacli  year.  Under  certain  cimdi- 
linns.  however,  the  State  Department  of  Public  Health  has  provided  in 
il>  rules  and  regulations  on  pneumonia,  for  the  compulsory  immunization  of 
individuals. 


390  iJiiAi.iii  coxuiTioNS  Ai-Ti:u  18T7 

Seriiins. 

Aiili>cniiii  111  'Jy|ic  I  inicumococinis  has  xielded  very  encouraging  re- 
sults, 'lliis  tyiir  causes  more  than  a  third  of  all  cases  of  pneumonia  with 
a  mortality  of  ".'.J  to  2!)  per  cent  withdut  serum.  The  administration  of 
specilic  antiserum  has  reduced  the  mortality  to  less  than  5  per  cent.  Un- 
fortunately many  cases  of  pneumonia  go  untyped,  hence  do  not  get  the 
benefit  of  serum.  I'mhaliK-  •,;,0(M)  lives  which  are  now  lost  annually  in 
Illinois   could   be    sa\ed    1)\    this   agent    alone. 

.Antiserums  for  Types  11  and  111  lia\e  ii<il  been  of  service  in  treating 
pneiiinonia  in  man. 

Isnldlio)!. 

Tin-  transfer  of  the  emphasis  in  pneumonia  from  the  clinical  aspect 
to  the  public  health  field  has  had  a  marked  effect  upon  the  problem  of  the 
control.  Isolation  and  quarantine  of  the  patient  has  been  a  factor  of  no 
little  importance  in  preventing  not  only  secondary  cases  among  those  in 
direct  contact  with  the  patient,  but  also  pneumococcus  "carriers"  who  in 
turn  go  out  and  infect  others.  The  rules  and  regulations  of  the  Illinois  Ue 
partment  of  Public  Health  (1925)  called  fur  isolation  for  a  period  of  14 
days  after  the  patient's  temperature  returned  to  normal,  unless  negative 
cultures  were  obtained  before  this. 

Whooping  Cough. 

Fifty  years  ago  whooping  cough  was  a  disease  which  was  apparently 
widely  prevalent  but  one  that  received  very  little  atteiuioii  from  the  State 
Board  of  Health  or  the  local  health  officers. 

With  the  im])erfectly  classified  and  incompletely  recorded  statistics,  we 
find  an  average  death  rate  of  Id. 3  per  IdO.ddO  ])opulation  for  the  years  1S80- 
188G  inclnsixe. 

The  tendency  to  waves  of  whooping  cough  epidemics  even  then  is  indi- 
cated by  a  total  of  9.")  1  deaths  recorded  for  years  18S0-1881  while  but  .")U 
were  registered  fnr  ISSI  and  1883.  Then  followed  ISSG  with  another 
marked  increase  when  oS.">  fatalites  were  recurded. 

.\  luore  peculiar  phenomenon  than  the  epidemic  waves  of  this  disease  is 
its  uiiii|ue  seasonal  character.  Instead  of  reaching  one  ])revalence  peak  dur- 
ing the  year  it  climbs  to  a  secondary  high  point  in  February,  then  recedes 
and  rises  again  to  the  maximum  high  level  of  the  year  about  July  first. 
Whether  the  incidence  is  great  or  small  the  case  re])orts  follow  this  un- 
usual seasonal  course   Iroiu  \ear  to  Aear. 

After  twenty-live  years  of  State  health  supervision,  we  find  no  improve- 
ment in  the  luiniber  of  deaths  from  whooping  cough.     The  average  annual 


HEALTH   CONDITIONS  AFTER   187(' 

Table  TO. 
Cases  of  Whooping  Cough  Reported  in  Illinois. 


391 


Yc-ar. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

1 
Jnly. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec.    1  Total. 

618 
1,650 

802 
1,214 

723. 
929 

554 
957 

818 
1,059 

1,206       4,721 

1920 

1,143 



1,222 

2,061 

1,204 

1,460 

1,464 

1,290  1  15,653 

1921 

1,530 

1,327 

1,482 

1,440 

1,466 

1,821 

1,928 

899 

606 

341 

378 

343  1  13,561 

1922 

412 

442 

551 

610 

657 

1,153 

1,H5  t 

1,069 

747 

563 

621 

786  1    8,756 

1923 

1,103 

973 

1,214 

1,095 

947 

892 

953  1 

694 

490 

488 

494 

501  1    9,844 

1924 

579 

620 

680 

550 

528 

524 

847 

782 

662 

641 

875 

950       8,238 

1925 

1,191 

1,04S 

1,121 

1,352 

1,184 

1,172 

1,149 

767 

547 

478 

453 

.  612     11,074 

1926 

739 

804 

939 

870 

827 

801 

894 

717 

714 

1    773 

958 

838       9,874 

779 

S96 

1,015 

850 

906 

1,089 

1,224 

1 

1 

Table  71. 
De.\ths  from  Whooping  Cough  in  Illinois  by  ^Months. 


Year. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June 

July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

Total. 

48 
26 
44 
45 
15 
45 
32 
26 
30 

65 
11 
83 
57 
20 
76 
43 
28 
36 

76 
25 
50 
43 
22 
68 
48 
24 
52 

83 
15 
43 
57 
22 
42 
48 
40 
58 

68 
21 
66 
68 
23 
44 
24 
33 
27 

58 
23 
29 
50 
13 
40 
19 
27 
19 

|53 
1    44 
47 
58 
18 
1    45 
31 
37 
23 

44 
35 
47 
39 
29 
45 
26 
36 
29 

41 
23 
22 
27 
15 
34 
25 
20 
21 

71 
21 
35 
18 
24 
33 
15 
22 
14 

58 
11 
41 
22 
16 
19 
19 
15 
35 

31 
15 
56 
11 
22 
30 
23 
7 
23 

696 

1919            

270 

553 

495 

239 

1     .-21 

353 

315 

367 

Table  ;2. 
Deaths  and  Death  Rates  from  Whooping  Cough  in  Illinois. 


1S60 
1.S70 


Rate  per 

Rat?  per 

100,000 

100,000 

population. 

Year. 

No.  deaths. 

l»->pulation 

22.3 

1905  

692 

13.2 

1906  

496 

9.3 

25.2 

1907  

530 

9.8 

1908  

491 

8.9 

448 

8. 

14.7 

1910  

393 

6.9 

281 

4.8 

7.2 

1912  

402 

6.8 

8  2 

388 

6.5 

7.5 

10.8 

WIS 

..     .            696 

11. 0 

1919 

270 

4.2 

9.3 

192(1 

553 

8.5 

1921    .     . 

495 

7.5 

10.3 

1922 

239 

3.6 

1923   ..    . 

521 

7.7 

10.9 

1924   . 

353 

14.2 

1925   

315 

4.4 

6.7 

1926   

367 

5. 

392 


IIKAI.TH   CONDITIONS  AKTKR   IHTT 


rate  for  19()"*-II)07  was  lo.T.  The  rate  twenty-five  years  earlier  was  about 
the  same. 

Here  ai^ain  lluciuatidn  in  nidrtalitv  is  shown  with  ','-H)  deaths  in  1903 
and  l)iit  34S  in  I  lid  I.  At  lliis  time  pnlilic  health  authorities  were  busy  with 
attempts  at  eontnilliiii;'  diphtiieria.  snialliiox.  typhoid  and  even  in  a  large 
city  like  C  hicago  did  little  or  nothing  tnwards  isolation  of  whooping  eough 
patients. 

While  it  is  generalK-  considered  that  results  are  not  yet  satisfactory  in 
our   efforts    at   control    of    whooping   cough,    progress   is    apparently    lieing 


^ti^^WMOopinG  ^  cougH 
'^mv^    in  iLLinois      ' 


Fui.  30.     ( The  1S60  Hue  should  indicate  a  rate  of  22.3. ) 


made.  (  ertainly  the  death  rate  has  declined.  Control  measures  have 
included  isolation  of  cases,  control  of  contacts,  exclusion  of  cases  from 
school  and  some  use  of  prophylactic  serum. 

The  average  annual  death  rate  for  years  1921-192G  was  5.5.  It  was 
10.3  fifty  years  earlier  and  10.6  about  the  turn  of  the  century.  Marked 
fluctuations  in  the  annual  mortality  from  whooping  cough  are  still  charac- 
teristic. There  were  twice  as  many  deaths  in  1921  as  in  1922,  the  1921 
figures  being  195.  against  238  for  1922. 


HEALTH   CONDITIONS  AFTEK    IS^T  3il."i 

At  this  writing  we  are  still  relying  on  early  quarantine  and  isolation 
as  chief  means  of  control.  How  much,  if  any,  credit  should  be  given  to 
vaccine  treatment  for  the  improved  death  rate  or  as  a  prophylactic  measure 
is  uncertain.  The  results  of  the  use  of  vaccine  are  conflicting.  Workers 
are  agreed  that  the  product  should  be  freshly  prepared, — preferably  not 
more  than  two  or  three  weeks  old.  As  a  prophylactic  measure,  vaccina- 
tion has  shown  considerable  promise  in  the  hands  of  several  investigators. 
Less  can  be  said  of  it  as  a  cure,  once  the  disease  has  become  established. 

In  1022  Orgel  reported  a  method  of  intracutaneous  injection  of  vaccine 
bv  which  the  disease  could  be  diagnosed  in  its  early  stages  and  thus  pre- 
ventive measures  taken  before  the  appearance  of  the  characteristic  whoop. 
Hull  and  Nauss  and  others,  however,  had  no  success  with  the  method. 

Infant  MoirrALiTV. 

A  considerable  numlier  of  sanitarians  regard  infant  mortality  rates 
as  indexes  to  general  health  conditions.  Some  go  further,  expressing  the 
opinion  that  infant  death  rates  reflect  the  character  and  efliciency  of  public 
health  service.  The  facts  fit  the  retiuirements  in  either  case  so  far  as 
Illinois  is  concerned. 

Fifty  years  ago  infant  mortality  in  Illinois  was  fully  twice  what  it 
is  now.  At  that  time  puljlic  health  service  had  scarcely  survived  the  labors 
of  birth  and  it  remained  an  infantile  organization  for  twenty-hve  years. 

Neither  birth  nor  death  registration  was  complete  fifty  years  ago  but 
there  is  abundant  evidence  that  infant  mortality  was  high.  In  1881  there 
were  218.8  deaths  among  infants  under  one  year  of  age  for  every  1,000 
l>irths  re]iorted.  Birth  reports  were  estimated  to  be  from  -JO  to  50  per 
cent  incomplete  and  death  reports  from  :iO  to  -10.  In  r,i2G  there  were  69. IJ 
infant  deaths  registered  for  each  1000  births  recorded.  Statistics  for  births 
and  deaths  were  complete  for  all  practical  purposes. 

In  ISSl  a  irifle  more  than  2  I  per  cent  of  all  deaths  recorded  were  among 
infants  less  than  one  year  old.  In  1l»2(i  a  irifle  less  than  11  per  cent  of  all 
deaths  were  among  persons  of  the  same  age  group.  This  is  positive  evidence 
of  substantial  improvement  in  infant  mortality. 

Then  there  is  the  evidence  of  actual  numbers.  For  the  six  years  ended 
with  188G.  when  the  population  of  Illinois  was  about  half  what  it  was  in 
li)2T.  there  were  ()';,iSll  infant  deaths  reported.  For  the  six  years  ended 
with  l!i2()  there  were  onlv  G0,.")2.')  infant  deaths  re])orted.  The  ratio  to 
population  in  the  more  recent  vears  is  less  than  one-half  of  that  for  the 
earlier  period. 

Probably  the  greatest  single  factor  in  the  saving  of  infant  life  was  ihe 
improvement  that  took  place  in  the  sanitary  quality  of  municipal  milk  sup- 


3SI4  lir.AI.I  II    CONDITIONS  AFTER   1877 

plifN  (luring  tlic  lilty  year  peridd.  rp  unlil  IH^I  there  is  no  record  of  less 
than  1  ],(•()()  infant  deaths  pi'r  annum  cxce])!  in  the  years  prior  to  1884.  Since 
1!)"-^1  tile  ]X'riod  during  which  the  safe  milk  campaign  has  been  stressed,  the 
total  numher  of  infant  (k-aths  has  never  reached  11,000  in  any  one  year 
while  for  each  of  the  three  years  ended  with  1926  it  was  less  than  10,000. 

The  ptriod  during  which  the  most  improvement  in  infant  mortality 
occurred  is  ihe  saiiu'  period  in  which  tlie  greatest  improvement  in  the  sanitary 
ipi.ditv  cif  municipal  milk  supplies  took  place. 

The  danger  to  infants  and  children  of  using  a  poor  milk  supply  is  well 
known.  Tliere  are  two  factors  concerned — the  presence  of  disease  produc- 
ing hacteria  .and  the  presence  of  enormous  numbers  of  other  bacteria,  not 
necessarily  iiathogenic.  hut  which  ii\er\\helm  the  digestive  tract  of  the  infant 

Table  73. 
Dk.\ths  of  Infants*  and  R.vtes  per  1,000  Births  Reported  in  Illinois. 


1880  10,968     1911 

1881  n,.S26       218.8         1912 

1882  -...  10,772       229.2         1913 


Kate  per 

Infant 

100.000 

leaths. 

population. 

10,968 

11,.S26 

218.8 

10,772 

229.2 

10,3K2 

224.8 

11.305 

246.4 

11,277 

237.5 

12.749 

215.3 

1S84  11.305       246.4         1916 

1885  11,277       237.5         1917 

1886  12.749       215.3         1918 

1019 
1890 1920 

1921 
1900  - .- 1922 

1923 

1907  11,947  140.  1924 

1908  11,774  154.3  1925 

1909  11,49-1  144.7  1926 

1910  - 12,281  149.1 


Rate  per 

Infant 

100.000 

leaths. 

population. 

11.113 

124. 

11,155 

108. 

11,607 

109.8 

14,518 

119.9 

14,029 

118.9 

13,109 

105.7 

11,148 

94.4 

11,641 

87.5 

10,644 

76. 

10.187 

74.9 

10,810 

78.9 

9,743 

69. 

9,S44 

71.8 

9,297 

69.3 

*  Less  than  one  year  of  age. 

Ijy  mere  numbers.  In  the  summer  time,  especially  when  the  weather  is  hot 
and  ice  difficult  to  obtain  in  sufficient  (|uantities,  infant  diarrhea  due  to  bad 
milk  has  been  in  the  ]iasi  extremel)-  ]ire\aleiU. 

The  i)asteurization  process  was  tirst  prjicticed  secretly  by  milk  men  to 
improve  the  keeping  ([uality  of  the  milk.  Its  merits  however  were  soon 
recognized.  As  early  as  JSItV  Nathan  Straus  began  the  distribution  of 
pasteurized  milk  in  New  York  City,  .\lthough  the  process  passed  through 
a  long  experimental  stage  with  much  faulty  technic  and  unreliable  apparatus. 
there  was  a  marked  improvement  in  milk  supply  with  a  consequent  reduction 
in  the  infant  death  rate. 

In  IIM)8  Chicago  passed  a  law  re(|uiring  compulsory  pasteurization  of 
milk  except  that  received  from  tuberculin  tested  cows.  This  was  the  first 
large  city  in  the  country  to  pass  such  an  ordinance.      In  HMii  by  an  executive 


HEALTH   CONDITIONS   AFTER    I  .S  , 


395 


order  pasteurization  was  extended  to  all  milk  in  Chicagu  and  snK\-  then  it 
has  been  strictly  enforced.  Other  cities  in  the  Stale  likewise  have  gradually 
been  supplied  with  more  and  more  pasteurized  milk. 

In  1922  the  State  Department  of  Public  Health  initiated  a  pasteuriza- 
tion program  with  so-called  model  milk  ordinance  intendetl  for  the  imjjrove- 
ment  of  milk  supplies  in  the  State.  During  the  next  five  years  60  cities  adopt- 
ed this  ordinance.  An  outgrowth  of  the  campaign  was  the  ])asteurization  law 
of  1925  which  required  all  plants  selling  pasteurized  milk  in  Illinois  to  ol)- 


Figure  31. 


tain  a  license  from  the  State  Department  of  Public  Health.  Not  onlv  was 
the  quality  of  pasteurized  milk  imijroved  but  there  was  a  large  increase  in 
amount.  In  1927  there  were  352  such  plants  in  the  State  (not  counting  the 
plants  supplying  milk  to  Chicago)  pasteurizing  390.702  gallons,  an  increase 
of  59,000  gallons  over  the  previous  year.  It  is  estimated  that  50  per  cent 
of  the  people  downstate  drink  pasteurized  milk,  while  all  of  Chicago  receives 
it,  or  a  total  of  more  than  four  and  half  million  of  the  seven  million  people 
in  the  State. 


SUMMARY  AND  CONCLUSION. 

Since  the  year  11)".'^  ends  a  liflv  year  jieriod  in  the  Hfe  of  the  Board 
and  Deparlnieni  of  l'nl)lie  i  leaUh  of  the  State  of  Illinois,  it  is  proper  that 
the  Department  should  use  the  occasion  to  gather  together  some  of  the  out- 
standing events  in  the  hi  alth  history  of  the  State  to  make  them  easily 
availal)le  for  those  interested.  To  those  who  have  an  interest  in  studying 
the  suhjici  more  exhaustively,  this  histiiry  may  stimulate  inquiry  and  offer 
suggestions  as  to  soin-ces  of  material.  The  narrative  and  ap]iraisal  of 
what  has  l)een  done  was  written  in  consultatii'n  with  a  few  of  the  men  who 
have  had  something  to  clo  with  the  effort.  It  is  to  be  regretted  that  it  was 
not  possible  to  ha\e  had  the  advice  of  man\-  who  did  not  jiarticipate  hut 
time  and  tide  do  not  wait.  Mow  valuable  the  apijraisal  would  ha\  e  1)eeil 
had  it  been  possible  to  summon  to  the  Boar<l  men  like  Ranch,  Reilly.  John- 
son and  Chambers,  the  men  who  planned  the  earlier  health  work  in  the 
State.  Hut  they  are  gone,  except  Johnson  who  is  advanced  in  years,  and  the 
best  that  can  be  done  is  to  judge  of  their  plans  by  the  effects  those  plans 
wrought,  immediate  and  remote. 

It  is  also  an  appro]iriale  time  to  speculate  somewhat  as  to  what  the 
future  holds.  In  this,  however,  what  is  said  must  be  regarded  as  general 
and   indic;ili\e   rather  than   specific. 

The  I  )irector  has  a  rather  definite  program  for  the  Department  of 
Health  for  a  ten  year  ])eriod.  There  is  no  uncertaint}-  in  his  mind  as 
to  what  sbnidd  lie  done  nor  as  to  his  intention  to  accomplish  this  program 
to  the  linut  of  his  strength,  influence  and  opportunity.  Such  uncertainty 
as  he  has  relates  to  the  vicissitudes  of  place  and  position  and  the  uncertain- 
ties of  the  pulilic  mind.  It  is  not  deemed  advisable  to  state  that  prograip. 
in  this  place. 

Sniirci's  (if  Mai(  I'liil. 

Those  who  wrote  about  conditions  in  the  upper  ^Mississippi  Valley  prior 
to  one  hundred  and  fifty  years  ago  had  but  little  interest  in  health.  It 
wiiuld  lie  f.iirt'r  to  s.iy  tb.it  the  reports  they  inade  were  on  subjects  other 
than  health.  When  he;ihh  is  mentioned  at  all  the  reference  is  brief.  There- 
fore the  health  record  of  the  perioil  is  not  worth  nnich  as  a  record. 

l'"rom  about  KSO  uulil  alxmt  IS.'iii  iju'  rt'Cord  while  more  xnluminous 
and  more  detailed  than  tli.il  of  the  preceding  period  is  onlv  of  relative 
value.  So  long  as  there  were  forts  in  and  ne.ar  the  Illinois  territory,  re- 
ports on  the  health  of  the  troops  stationt-d  in  them  were  made  periodically. 
But  these  are  of  limited  value.     Prior  to  the  War  of  1812  and  even  during 

( ;!!)i; ) 


SUMMARY    AXD   CONCLUSION  SflT 

that  war  the  medical  department  of  the  United  States  army  was  poorly 
organized.  Surgeon  General  Forrv  was  the  first  of  the  army  medical  officers 
to  grasp  the  possibility  of  evaluating  the  healthfulness  of  different  sections 
of  the  country  through  the  opportunities  of  the  military  posts.  The  lay 
writers  who  told  of  health  conditions  in  the  territory  and  state  when  they 
lectured  and  wrote  books,  magazine  articles,  newspaper  articles  and  letters 
back  home  supplied  a  considerable  part  of  the  record  prior  to  1850.  Soon 
after  the  beginning  of  the  century.  Dr.  Daniel  Drake  established  the  Medi- 
cal and  Physical  Journal  in  Cincinnati.  Before  long  the  physicians  of  Illi- 
nois began  writing  for  this  Journal.  .\  little  later  Dr.  Drake  made  the  first 
of  at  least  two  voyages  of  discovery  in  health  matters  in  Illinois,  reporting 
at  length  and  in  detail  in  his  Journal. 

A  little  later  other  medical  journals  were  established,  in  St.  Louis, 
Louisville,  Buffalo  and  Chicago,  and  Illinois  physicians  began  writing  for 
these  Journals  and  occasionally  for  the  American  Journal  of  the  Medical 
Sciences  in  Philadelphia  and  in  other  eastern  journals.  In  1846  the  forma- 
tion of  medical  societies  was  begun  at  Lawrenceville,  Illinois.  In  1848  the 
American  Medical  Association  was  formed  with  the  cooperation  of  Illinois 
physicians.  In  1850  the  Illinois  Medical  Society  was  formed.  The  Chi- 
cago Medical  caine  in  the  same  year.  Much  of  such  record  as  there  is  of 
health  conditions  in  Illinois  is  found  in  the  pages  of  these  journals  and  the 
transactions  of  these  societies.  However,  all  of  this  record,  including  that 
of  the  physicians  is  opinion,  on  evidence  and  subject  to  the  limitations  of  such. 

The  Federal  Government  began  making  its  decennial  census  reports  in 
ITiMi.  Prior  to  1850  these  reports  contained  no  demographic  material  ex- 
cept number  of  population,  increase  in  numbers  during  the  previous  decade, 
distribution  of  population  geographically  and  as  to  se.x.  age.  color,  racial 
stock  and  special  classes.  In  1850  a  little  vital  statistics  was  given.  In 
1860  still  more.  But  these  incursions  into  vital  statistics  were  timid  and 
halting  and  oftentimes  inaccurate  and  misleading.  The  introduction  to  the 
report  of  ]s.")(i  said:  "The  tables  of  the  census  wjiich  undertake  to  give 
the  total  number  of  births,  marriages  and  deaths  in  the  year  preceding 
the  first  of  June  1850  can  be  said  to  ha\-e  very  little  value".  Xevertheless 
the  policy  was  continued.  Each  census  year  the  reports  were  increasing!}- 
accurate  and  detailed.  In  lltuo  the  policy  of  reporting  vital  statistics  an- 
nuallv  was  adopted.  Chicago  began  reporting  vital  statistics  in  a  very 
limited  wav  in  1843.  These  were  inaccurati-  as  well  as  incomplete.  In  the 
]cS70  report  Dr.  Ranch  gave  an  estimate  of  the  degree  of  incompleteness 
and  applied  a  corrective  factor  for  all  of  the  earlier  reports. 

Nevertheless  the  record  from  somewhere  about  1843  to  1850  on  is  a 
statistical  record  as  well  as  one  Ijased  on  testimony  of  (ipinicm.     In  all  jimlia- 


.SOS  SrMM.\l<\     AM)   COXCI.USION 

bility  Ijctwci-ii  l.st;i  anil  IS<i3  the  icslimony  of  ojiiniim  was  Ijuttur  and  more 
dependable  than  the  statistical.  Since  about  the  latter  d;ite  the  statistical 
source  of  material  has  been  the  more  dcpend;d)le. 

Since  the  l-'rench-Canadians  and  the  Indians  left  few  descendants 
in  the  Slate,  they  can  be  eliminated  from  an  estimate  of  the  physical  vigor 
of  the  stock.  Likewise  since  they  made  no  outstanding'  contribution  of  a 
disease  they  can  be  eliminated  from  this  limited  study  of  the  diseases  of  the 
State.  When  malaria  became  so  prevalent  and  deadly  soon  after  1780  it 
made  a  smoke  screen  beyond  which  it  is  not  easy  to  see  any  im|iortant  disease 
in  the  prixeding  period.  Therefore,  it  must  be  assumed  that  there  were 
none  of  outstanding  importance  though  rheumatism.  ]ineinuonia  and  the 
diarrhoeas  must  have  been  much  in  e\i(lence. 

Ural  til  J7S0  In  is;  7. 

There  is  no  record  for  the  State  of  Illinois  prior  to  1ST7  as  to  the 
physical  \igor  of  the  people,  the  birth  rate,  the  size  of  families,  the  aver- 
age length  of  life,  the  endurance,  presence  and  absence  of  physical  and  men- 
tal defects,  average  stature,  physical  prowess,  positive  health  so-called  and 
prevalence  of  non-report.nble  diseases  either  fatal  or  non-fatal.  This  state- 
ment i>  onK  |iarti;ill\  true  as  to  ^uch  items  as  ph\  sical  \  igor.  birth  rates, 
size  of  families,  length  <if  life,  endurance  and  physical  prowess,  as  to  each 
of  these  items  there  is  a  limited  amount  of  evidence  of  opinion,  most  of  which 
is  very  general  and  but  little  circumstantial.  In  collecting  material  for  this 
narrative  it  seemed  best  to  base  the  jiresentation  on  those  items  as  to 
which  the  evidence  was  best.  That  almost  limited  it  to  the  major  forms 
of   Communicable   diseases   commonU'   known   as   the    reportable   diseases. 

\\  hen  the  ])eriod  prior  to  187  7  is  comjiared  with  that  since,  the  record 
shows  an  almost  unbelievable  gain.  In  brief  statements  relative  to  each 
of  several  diseases  and  as  to  general  unhealthfulness  and  general  death 
rates  opinion  will  be  gi\en  as  to  what  in  a  general  was  has  been  the  con- 
tribution of  the  state  ;md  local  health  dejiartmrnts  to  that  end, 

(Icinriil  I '  iilicaHlif  iilurss. 

This  heading  is  used  liecause  it  was  used  in  reporting  health  prior  to 
187  7.  in  the  early  da\  s  the  geuer.al  re[)utation  of  the  state  as  to  health 
was  bad.  It  is  now  good.  The  death  rate  is  low  not  onlv  as  compared  with 
that  of  other  states  but  as  conipart'd  with  l'"uropean  countries.  So  far  as 
the  gross  or  imcorri'cti'il  death  rate  from  all  causes  is  concerned  the  yearly 
records   Irom  this  and  the  European  countries  is  accurate  and  dependable. 

The  Illinois  raci.il  stock  is  exceptionally  heterogeneous.  By  reason  of 
immigration  between  this  and  other  countrit's.  between  the  states  and  between 
the  urban  and   the   rural  districts  the   poimlation  is  exceptionally  unstable 


SUMMARY  AND  COXCLUSION  3!)9 

Statistically.  However  the  contrast  between  then  and  now  is  so  great  that 
minor  variations  do  not  obscnre  it.  In  less  than  one  himdred  years  a  most 
unhealthy  region  has  become  one  where  health  is  of  the  best.  In  effecting 
this  change  several  factors  have  operated.  One  has  been  the  change  in  the 
country  itself  especially  improvements  which  liave  resulted  from  clearing 
the  land  and  draining  it.  Another  has  Ijeen  the  change  in  the  people 
such  as  growth  in  intelligence  and  knowledge,  elevation  of  the  standards 
of  living,  increase  in  earning  power  measured  in  purchasing  power  of  the 
dollar  and  learning  how  to  live  among  their  neighbors  as  well  as  with 
their  families  and  the  individual  with  himself.  Another  has  been  the  im- 
proved service  rendered  by  the  medical  profession  in  its  various  divisions 
of  doctors,  dentists,  nurses,  druggists  and  hospitals.  And  a  fourth  is  the 
preventive  medicine  agencies  principally  the  state  and  local  health  depart- 
ments and  also  in  some  measure  the  cooperating  agencies  for  prevention  of 
disease.  For  the  general  improvement  in  health  and  the  reduction  in  the 
death  rate  between  the  period  prior  to  187?  health  agencies  are  eiuitlefl 
to  half  the  credit.  In  order  to  establish  that  claim  they  credit  themselves 
with  the  generalship,  strategy^  and  leadership  in  the  health  campaign,  with 
their  activities  in  education  <.if  the  jnihlic  in  health,  their  propaganda  to 
interest  as  well  as  to  inform  the  public  as  well  as  with  their  more  direct 
and  specific  activities  in  health  promotion  and  disease  control.  They  claim, 
moreover,  that  even  after  crediting  other  factors  with  their  half  of  the  ac 
complishment  the  health  agencies  show  a  return  of  improvement  and  iiene- 
fit  of  and  to  the  people  which  can  not  be  approximated  by  any  other  arm 
(^f  government.  This  is  because  the\-  ha\e  made  prevention  their  field 
and   prevention    is   economically   sound. 

Mdhnid. 

Malaria  was  the  great  menace  to  lllimiis  in  the  period  when  its  verv 
existence  was  in  the  balance.  It  wa^  escrywhere  in  the  State.  It  was 
^aid  to  be  endemic  and  periodicalh'  became  so  prevalent  that  it  was  said 
to  be  eijidemic. 

The  last  great  epidemic  wave  was  in  IS?-^.  The  territory  in  which  it 
is  endemic  has  gradually  been  lessened  until  now  some  of  the  mosquitoes 
and  .some  of  the  people  are  infective  in  only  aliciut  fifty  foci  located  in  about 
twelve  counties.  Shortly  there  will  be  no  endemic  malaria  in  the  State.  In 
making  this  transformation  the  largest  single  factor  has  been  drainage.  The 
health  department  using  the  term  in  its  inclusive  sense  can  only  claim  a 
minor  ])art  in  this  great  achievement:  yet  they  have  contributed  and  are 
continuing  to  do  so. 


•100  SUMMARY   AND  CONCLUSION 

Tiqihii'iil  Fen  r. 

Ill  all  ]inil],iliility  llu-n-  was  suiiic  typhoiil  fe\cr  in  thi-  slate  from  its 
early  settleiiuiU.  As  the  I'o.t^  of  malaria  was  lifted  typhniil  came  to  he 
recognized.  The  disease  increased  as  did  the  density  of  impulalioii.  I'^ir  this 
increase  proijressive  ])ollnti(iii  of  water  supplies  was  the  principal  factor. 
The  prevalence  of  the  disease  was  at  its  ])eak  in  tin-  first  half  of  the 
nineties. 

It  has  now  become  a  dist-ase  of  minor  importance.  For  this  improve- 
ment the  health  agencies  can  claim  the  larger  part  of  the  credit.  To  do 
so  however  they  must  absorh  the  water  and  sewage  departments  claiming 
them  as  ]}arts  of  the  health  machine. 

Y cUoir  Fi'rcr. 

This  disease  is  scarcely  a  memorv  in  this  State.  Xe\ertheless,  the 
health  machinery  did  its  full  duty  in  the  few  epidemics  that  occurred  and 
it  has  fiuictioned  in  throwing  a  w.ill  of  protection  around  the  State  when- 
ever danger  threatened.  They  can  claim  credit  for  whatever  of  securitv 
was  added  to  that  which  the  location  and  relative  freedom  from  vellow 
fever  mos(|nitoes  supplied. 

Cholera. 

This  disease  lias  not  reached  within  li\e  hiuuhed  miles  of  Illinois  since 
1877.  The  only  credit  the  ."^tate  Board  of  Health  can  claim  is  that  they 
have  added  to  the  securitv  of  the  pieople  when  the  disease  has  threatened 
on  a  few  occasions.  The  local  health  departments  are  entitled  to  more 
credit.  They  were  active  in  every  epidemic  wa\e  which  swept  over  the 
state  after   1S3:>. 

At  times  cholera  caused  conditions  to  be  \ery  liad  but  just  how  Ixid 
they  might  have  lieen  had  the  local  health  departments  and  the  indi\i<lual 
doctors  failed  to  function  is  bey<ind  the  imagination. 

TjiiiliKs  <iii(l  Plague. 

Illinois  has  been  spared  e[)idemics  of  these  diseases.  Since  no  great 
epidemics  of  them  have  prevailed  in  .Vmerica  no  particular  eti'ort  has  been 
required  to  protect  the  state. 

Milk  SicJaiess. 

This  form  oi  poisoning  once  of  major  interest  in  Illinois  is  now  unim- 
portant except  in  iwo  or  three  counties  and  for  about  two  months  in  the 
year. 

In  this  transformation  clearing  the  woods  and  im]iroving  the  pastures 
has  been  the  controlling  factor — the  health  departments  have  contributed 
notbiiiL''. 


SUII.MAKV    AXD  COXCLUSION  401 

Siuil'cliitr. 

'I'liis  f(irm  lit  animal  ])oi>(>nini;  once  ranl<L-(l  with  milk  sickness,  a  form 
of  vegetable  poisoning,  in  iniiwrtance.  Jt  is  now  trixial  causing  no  deaths 
and  almost  no  sickness.  Clearing  the  countr)  is  entitled  to  credit  for  the 
improvement. 

Smallpox. 

This  disease  was  a  very  great  nienuce  priur  td  is;;  and  for  at  least  ten 
years  thereafter.  It  was  fairly  prevalent  during  the  following  ten  years. 
J'\ir  thirtv  vears  it  has  been  a  ];otential  rather  than  a  present  danger  most 
of  the  time.  Jts  relative  control  is  one  of  the  sanitary  achievements  of  the 
century.  However,  the  record  of  the  L'nited  States  as  regards  the  control 
of  smallpox  when  compared  with  that  of  the  countries  of  northwestern 
Europe  is  disgraceful.  It  is  conunonly  cited  as  proof  that  something  more 
than  the  gradual  growth  of  jniblic  intelligence  is  necessary  to  prevent  ejii- 
demics  of  this  disease.  P'or  the  achievement  in  lessening  the  prevalence 
of  smallpox  the  health  agencies  can  claim  much  the  largest  part  of  the  credit. 

Scarh'l  Fever. 

Scarlet  fever  has  become  a  disease  of  secondary  importance.  In  spite 
of  the  increased  density  of  population  and  the  increased  frequency  and 
intimacy  of  contact  of  people  the  disease  has  declined  in  pre\alence.  The 
theory  is  that  the  greatest  decline  in  prevalence  was  that  which  occurred 
])rior  to  IS'.i;  and  that  the  princi|)al  decline  since  then  has  been  in  the  \iru- 
lence  of  the  disease — the  case  fatalit)-  rate.  This  is  in  great  measure  true. 
For  this  latter  improvement  the  better  service  of  the  medical  profession 
and  the  elevation  of  the  general  standards  of  cleanliness  have  been  the 
[irincipal  contributing  factors.  For  the  lessened  prexalence  of  the  disease, 
the  health  departments  can  claim  most  of  the  credit.  Taking  the  field  in 
its  entirety  the  health  agencies  are  entitled  to  somewhere  near  half  (if  the 
credit. 

I)i [lilt In  rui. 

Ibe  \ei"\-  great  decrease  in  the  pre\:ilence  and  in  the  fat;i]it\-  of  diph- 
theria is  one  of  the  achiesements  of  which  society  can  be  proud.  I'rior 
to  the  discovery  and  general  use  of  antitoxin  the  treatment  of  di|ilitheria 
was  symptomatic.  Health  departments  can  claim  the  credit  for  having 
popularized  the  use  of  this  remedy.  The  medical  ]irofession  are  entitled 
to  the  credit  for  using  it  intelligently.  I'^ollowing  its  introduction  and  use 
the  death  rates  from  diphtheria  fell  markedly.  Due  to  the  fairly  general- 
ized and  increasing  use  of  vaccination  against  the  disease,  diphtheria  is 
rapidly    shrinking    in    imjjortance.      Within    a    decade    diphtheria    will    be    of 


402  SUM.MARV   AM)  COJ'CLUSION 

st'Coiiilary  im|icirlaiKH-.  TIk-  licahli  a.L;riK-ic^  arr  riititkd  to  imich  more 
than  half  thi'  crc(ht  t(ir  this  improNx-mcul  parliciilarly  if  tliey  admit  to 
iiH-nihcrsliip   the   ix-si-arcli   workers. 

W}ioupir,g  CoHfili. 

The  decrease  in  this  disease  has  hei-n  marked  thoiij^di  in  it  there  lias 
been  nothing  spectaenlar  or  dramatie.  The  health  agencies  claim  si  me 
of  the  credit  though  much  of  it  belongs  to  the  gradual  growth  of  public 
iiUelligence. 

Mraslrs. 

The  best  that  can  be  said  for  the  measles  tight  is  that  the  disease  has 
been  held  in  check.  That  the  people  from  the  cities  are  now  in  a  better 
position  as  regards  measles  when  emergencies  develop  is  somewhat  to  the 
credit  of  health  agencies.  Within  the  last  ten  or  fifteen  years  it  has  been 
discovered  that  the  secondary  infections  in  measles  are  of  more  importance 
than  the  primary  disease,  that  something  can  be  done  to  prevent  these 
secondary  infections  and  that  the  bacteriology  of  these  secondary  infections 
is  hable.  The  credit  for  these  discoveries  belongs  to  the  medical  pro- 
fession and  to  the  research  men.  It  seems  that  the  bauterial  cause  of 
measles,  an  antitoxin,  and  a  vaccine  have  been  discovered  or  are  about 
to  be  discovered.  Should  these  supposed  discoveries  be  established  the 
stage  will  be  set  for  the  control  of  measles.  It  will  then  be  up  to  the  health 
agencies  acting  as  boards  of  strategy  to  lav  and  to  execute  i)lans  for  the 
control  of  measles.  For  what  has  been  accomplished  the  health  agencies 
can  not  claim  a  major  credit. 

Eri/sljxias. 

This  disease  once  prevailing  always  as  endemic  and  occasionally  break- 
ing out  into  epidemics,  at  least  one  of  which  was  almost  if  not  quite  pan- 
demic, has  become  a  fairly  unimportant  disease.  The  recent  discovery  of 
an  antitoxin  for  it  promises  still  further  improvement.  A  part  of  the 
importance  of  erysipelas  in  the  I'ast  was  due  to  its  close  relationship  to 
puerperal  fever  and  scarlet  fever  and  its  relationship  albeit  less  close  to 
meningitis  and  pneumonia.  Ihe  principal  factor  in  the  decrease  in  ei"y- 
sipelas  is  the  elevation  of  the  general  standards  of  cleanliness  and  other 
general  standards  in  some  meastn-e.  The  medical  profession  are  doing  their 
work  better  and  that  is  contrilnuing  to  the  end.  The  health  agencies 
claim  some  of  the  credit  though  they  are  not  in  the  first  rank. 

Puerperal  Fever. 

It  is  customary  to  sav  thai  the  niorialit\-  rate  of  mothers  in  childbirth 
has  not   inipro\i-(l.     Tliis  ma\    be  true   when   comparison   is  ma<le  between 


SUMMARY    AXD   CONCLUSION  403 

present  day  conditions  and  those  of  the  recent  ])ast.  It  is  not  true  if  com- 
parison is  made  between  the  period  before  ISTT  and  that  after  ISTT.  There 
is  less  puerperal  fever  than  there  was;  princi])ally  because  of  the  elevation 
of  standards  of  general  cleanliness  and  application  of  the  discovery  by 
Oliver  Wendell  Holmes  that  puerperal  fever  is  contagious.  Better  medical 
service  is  a  factor.  The  Chicago  Health  Department  under  Dr.  A.  R 
Reynolds  inaugurated  a  midwife  and  obstetric  service  in  the  °arly  part  of 
the  present  century. 

Me)ii)i(iitis. 

Meningitis  was  once  a  periodically  epidemic  (Hsease  causing  a  heavy 
death  rate.  It  is  rarely  epidemic  now.  In  fact,  very  rareh' — almost  nc\cr. 
This  improvement  is  partly  due  to  health  departmem  work  and  partl\-  due 
to  knowledge  of  the  danger  of  cmwding,  particularK'  in   sleeping  (piarters. 

Infant  Mortaliti)  and  Mortal  if  ij  of  Children  Under  Fire. 

In  no  other  division  is  the  im])r()\ement  in  health  more  definitely  indi- 
cated than  in  that  whicii  relates  to  young  children.  The  statistical  proof 
of  decrease  in  the  death  rate  of  babies  under  one  year  of  age  from  all  causes 
is  not  so  easily  arrived  at  in  Illinois  as  elsewhere  because  the  State  has  not 
been  long  in  the  Birth  Registration  Area  and  Ijirths  are  not  yet  all  registered. 
In  other  states  the  registering  of  births  is  better  incorporated  in  the  uiorcs. 
Nevertheless,  there  is  proof  enough  to  establish  the  fact  that  the  inse- 
curity of  baby  life  and  child  life  which  was  accepted  as  ine\itai)le  three 
quarters  of  a  century  ago  would  provoke  remonstrance  if  n(.it  rebellion 
today.  Little  of  this  im]>ro\ement  came  before  187  T.  The  great  era  of 
betterment  l)egan  about  I'.Ho.  Tiie  health  agencies  can  justly  claim  credit 
for  half  of  the  gain,  the  other  part  being  divisible  between  better  medical 
service,  elevations  of  standards  and  improvement  in  environment.  'i'he 
largest  single  factor  in  bringing  about  the  improvement  was  the  improve- 
ment in  the  milk  supply  which  stimulated  improvement  in  other  foods  and 
a  decrease  in  the  prevalence  of  flies.  The  health  agencies  fought  the  bat- 
tle for  better  milk. 

Diarrhoeaf:  and  Difsenterles  In  Adults. 

'i'hese  disorders  were  responsible  for  heavy  deatli  rates  and  sickness 
rates  among  the  Indians,  the  French-Canadians  and  the  .American  settlers 
living  in  Illinois.  This  continued  up  to  and  after  is:;  but  not  very  long 
thereafter  as  an  important  ailment.  They  have  \irinall\-  disajjpeared.  Im- 
provement in  standards  of  living  and  in  food  and  water  supplies  and  better 
medical  service  are  the  principal  factors  which  have  brought  about  this 
improvement.     The  contril)Ution  of  health  activities  consisted  in  impro\ing 


i04  Sr.MMARV    AND   C'dXCI.USION 

water  ami   iuod  supplies,  in  i-(lm-aliiii;  the  people  and  ccnitrilniting  indirectly 
to  the  elexalion  of  stan<lards. 

Decrcdsr  ill  I  III'  SiniiiiK  r  Sickness  lUtics. 

Summer  time  was  formerly  four  to  six  times  as  unliealthful  as  it  now 
is.  The  pre\ailin{^  illnesses  of  the  period  were  malaria,  typhoid  and  the 
diarrhoeas.  l'"or  this  improvement  the  health  agencies  are  largely  due  the 
credit.  Their  campaigns  against  flies  and  filth  generally,  their  milk  fights 
and  ljal)\  sa\ing  campaigns  are  directed  principally  against  those  disorders 
which  prevail  in  summer.  Ileltei-  medical  service,  impro\e;l  saniiation 
and  higher  si.-r\  ice  have  coutrilnUed  to  the  end. 

Cdiishiii  jit  inn. 

Tn  the  earl\-  davs  Illinois  enjoyed  but  (Mie  good  reputation  for  health. 
That  related  to  consumption.  When  the  figures  became  available  soon 
after  1850  it  was  found  that  at  least  at  th;it  date  the  reputation  was  not 
deserved  though  it  may  possibly  have  been  earlier.  Between  1850  and  llioo 
there  was  a  considerable  reduction  in  the  ])revalence  of  ctmsumption.  '1  his 
was  the  result  of  elevaticn  of  standards  more  than  any  other  single  cause. 
Recognition  of  the  contagiousness  of  the  disease  was  a  related  cause  that 
was  helpful  in  effecting  the  improvement.  The  Chicago  figures  show  that 
just  pric  r  to  HHi^  there  was  a  slight  increase  in  the  disease.  Between  1907 
an<l  i;i"i-  there  was  a  second  great  decrease.  T^'or  this  decrease  the  activities 
of  health  agencies  are  entitled  to  most  of  the  cre<lit.  The  decrease  has 
come  to  a  stand  still  since  1922  just  as  it  did  soon  after  1900. 

hifiicnza. 

There  has  been  no  success  in  comb.ating  influen/a. 

Till'  I'ni'iiinoiiKis. 

The  pneumonia  rale  was  comparatis  eh  low  prior  to  1S7T.  It  rose 
intermittently  until  ;ibout  192n,  although  the  intercurrent  influenza  pandemics 
and  endemics  make  interpretation  of  the  pneumoni.a  figures  difficult  and 
even  impossible  at  times,  h'or  some  reason  the  disease  or  group  of  diseases 
seem  to  have  been  on  the  decline  since  about  1920.  It  is  difficult  to  intcr- 
])ri't  the  meaning  of  this  or  assign  thi'  credit  for  it. 

Till'  Stall-  Ilnillli  Drjxirliiiinl: 

The  credit  for  establishing  the  ."^tate  Health  Department  lielongs  to 
the  Illinois  Medical  Societ\  though  the  Aesculapian  Society  of  the  Wabash 
Vallev  first  pn■^hed  the  proposal  before  the  General  Assembly.  It  was  a 
resolution  passed  b\-  the  .'^tate  Society  which  sent  a  committee  to  the  legis- 
lature to   insist   upon   the   necessary  legislation,      llowexer,   the  good   repu- 


SUMMARY   AXD  CONCLUSIOX  405 

tation  enjoyed  by  the  Chicago  Health  Department  made  friends  for  the  jjro- 
posal.  The  Chicago  Heahh  Department  owed  its  existence  to  the  Chicago 
Medical  Society  and  to  the  individual  efforts  of  strong  medical  men  who 
belonged  to  that  society.  The  same  general  statement  applies  to  ntlu-r 
local  health  departments.  The  Municipal  Tuberculosis  Sanitarium  in  Chi- 
cago owes  its  existence  to  the  Chicago  Health  Department  aided  by  the  Chi- 
cago Tuberculosis  Institute. 

Ixcfinlatiuit  of  the  PracHcf  of  Midicnir. 

No  part  of  this  narrative  has  more  jieculiar  angles  than  that  which 
relates  to  the  proposals  to  regulate  the  practice  of  medicine  and  to  i^romote 
medical  societies  as  post-graduate  medical  schools  than  the  reference  to  acts 
of   the   territorial  legislature  and   several   legislatures   thereafter. 

The  proposals  to  establish  a  State  Health  Department  which  came  from 
the  Aesculapian  Society  and  later  from  the  State  ]\Iedical  Society  provided 
for  two  objectives.  One  of  these  was  regulation  of  the  practice  of  medi- 
cine. In  187 T  and  for  nearly  forty  years  thereafter  this  was  the  chief  ob- 
jective of  the  Board  of  Health. 

Between  1900  and  1905  the  State  Medical  Society  became  greatly  in- 
terested in  separating  this  objective  from  the  other  objective,  the  promotion 
of  health.  However,  it  was  not  until  I'.in  that  this  was  accofplished.  The 
society  was  right  in  its  judgment  as  experience  si  on  demonsrrated.  Cnder 
the  old  order  too  much  of  the  Department's  energy  and  time  was  taken  up 
with  regidating  the  practice  of  medicine  and  too  little  of  resource  remained 
for  promoting  health.  There  was  some  advantage  in  ccnsolidating  ihe 
great  professional  army  engaged  in  curing  disease  with  the  small  but  com- 
pact army  engaged  in  fighting  it.  But  in  practice  it  has  been  found  that  the 
practice  of  medicine  is  better  regulated  in  the  Department  of  Registra- 
tion and  the  Dejiartment  of  rublic  Health  is  left  some  energy  and  en- 
thusiasm   for  ])lanning  to  pre  mote  health. 

rhitfitrm. 

This  chapter  and  narrative  is  brought  to  a  close  bv  turning  from  the 
jiast  to  the  future  and  giving  some  objectives  for  the  next  ten  years  and 
also  projecting  aspirations  and  possibly  hopes  for  a  fifty-year  period.  In 
doing  this  it  is  advisable  to  state  a  platform  reciting  the  basic  principles  upon 
whicii  the  Department  stands  and  hopes  to  stand. 

The  State  Department  of  Public  llealth  is  the  centralized  agencv  for 
health  promotion  and  disease  prevention  in  the  ."^tate.  It  is  not  an  agency 
for  the  cure  of  disease  or  for  the  custodial,  remedial  or  rep;irati\e  care 
of  the  sick  or  convalescents.  \Mien  perchance  it  becomes  necessary  to  care 
for  the  sick  as  a  measure   for  protecting  others  against  contagion   it   will 


40()  SUM.\1\K\     AM>    lO.VCr.l'SION' 

^\\v  till'  iiu)>l  huiiKUK-  and  scienlil'ic  care  it  can.  lint  snch  assnniption  of 
(Inly  as  tlic  care  nf  tlir  >>ick  implit-s  is  merely  a  tiMiiporarN-  expedient  and 
one   from   which  it  is  seekint;-  al\va\s  to  esra])e. 

The  \arioiis  schemes  for  heahii  insniance  so  cahed  are  reall\-  i)knis 
for  the  economic  cru'e  of  the  sick.  Soini'  of  them  have  some  excellent  fea- 
tures for  the  pre\eniion  of  disease.  llo\ve\er,  curative  care  is  their  chief 
objective  and  snch  heint;-  the  case  the\-  are  lie\'ond  the  domain  of  this  De- 
partment. If  this  Deiiarlment  shonld  he  called  on  to  cooperate  with  such 
a  scheme  it  w  i  uld  hold  that  it  was  its  dut\'  to  do  so  in  so  far  as  the  pre- 
vention part  of  the  proj^'ram  is  concerned.  .\  few  years  ago  the  De- 
partment found  itself  jjiving  reparative  or  after  care  to  persons  wIkj  had 
recovered  from  infantile  paralysis.  Since  these  persons  were  not  infec- 
tive the  problem  of  giving  them  reparative  care  w-as  beyond  the  held  of 
the  Department.  Forttmately,  the  State  Rotary  Clubs  and  the  Sb.rin^-rs  were 
found  willing  to  assume  the  duty  of  giving  this  after  care. 

The  Department  stands  on  the  same  platform  with  relation  to  su[)ply- 
ing  drugs  free.  It  is  its  duty  to  supply  vaccines  and  nitrate  of  silver  so- 
lution and  other  drugs  fir  pre\ention.  It  should  not  supply  any  drug  for 
cure.  The  State  Dejiartment  of  Public  Welfare  maintains  a  line  of  hos- 
pitals and  other  institutions  for  the  care  of  those  who  are  mentally  or 
phvsically  sick. 

The  I'epartment  of  Public  Idealth  has  no  dut\  that  calls  it  to  intrude 
into  the  field  cf  the  Department  of  I\iblic  Welfare.  When  cjuestions  of 
prevention  arise  in  that  field  the  Department  of  Health  is  willing  and  anxious 
to  assume  its  full  measiu'e  of  responsibility.  The  law  establishes  educa- 
tion of  the  ])nblic  and  ])ropagan(la  for  health  as  among  the  duties  of  the 
Department  of  Public  Health.  This  is  a  pro])er  prox'isicn  above  all  in  a 
democracw  It  is  a  fundamental  factor  in  prevention.  The  State  Depart- 
ment of  Public  Health  is  an  ad\isor  of  the  legislature  in  matters  of  health 
promotion.  This  is  a  recognized  function  of  a  1  )ei)artnient  and  is  the 
basis  of  (he   relations  between  it   and  the  legislative  branch  of   government. 

."^ince  the  meaning  and  force  of  laws  are  determined  by  the  judiciary. 
the  Department  carries  some  responsibility  for  keeping  that  bocly  informed 
as  to  what  is  coninion  information  on  health  subjects  an  1  giving  it 
information  more  dirt-clly  when  called  in  to  do  so. 

Tin-  Stale  Department  of  Public  Health  considers  that  the  duty  of 
j/lanning  campaigns  against  disease  and  promoting  health  rests  on  its  should- 
ers. .Much  of  tlu'  attack  and  defense  is  commanded  and  executed  by  local 
health  departments.  The  State  Department  of  Public  Health  promotes 
the  interests  if  local  lu-altb  departnn'nts  where\-er  it  can  do  so.  It  lends 
them    all    the   aid    it    can.      It    ba^    the    right    to    interfere   localp-    onl\-    when 


SUMMARY    AM)  CONCLUSION  -107 

the  local  department  is  so  derelict  that  tlie  people  of  other  coinniunities 
are  endangered.  A  breakdown  in  Icical  adniini.stratiun  ilial  has  local  effect 
only  is  a  local  matter  calling;  for  nci  State  interxentiun.  The  people  pro- 
gress fastest  when  thev  reap  their  own  rewards  and  snft'er  their  own 
punishments.  But  if  the  local  department  is  inefficient  to  such  a  degree 
as  to  imperil  the  State  generally  the  State  Department  has  the  right  to 
intervene.  If  the  enemy  is  jiouring  through  a  certain  gaj)  and  over  the 
State  generally  the  State  has  the  right  to  stop  the  gap  regardless  of  where 
it  may  lie. 

The  same  princi])les  apply  tn  the  relati(  n  i)f  the  Department  to  the 
practitioners  of  medicine.  In  the  battle  line  against  disease  tlie  indi\idual 
is  in  the  outermost  skirmish  line.  Next  comes  the  home  and  then  the 
school.  Then  comes  the  first  professional  line  of  defense,  the  doctors  and 
the  hospitals.  Still  further  back  are  the  first  line  of  Ilealth  Department 
workers.  The  service  rendered  by  physicians  and  hospitals  is  constant — 
never  ending  and  valuable.  The  State  Department  of  Public  Health  never 
interferes  in  the  domain  of  any  practising  physician  or  hospital  except  where 
it  becomes  necessary  for  the  protection  of  society.  In  almost  all  cases  a 
satisfactory  adjustment  between  these  cooperating  agencies  is  matle  and 
it  is  of  a  kind  that  works  efficiently,  economically  and  satisfactorily. 

The  Fiitiiir. 

This  narrative  may  give  the  impression  that  the  ultimate  in  attain- 
ment has  been  reached  and  that  health  can  nut  be  further  improved.  It  is 
largely  to  correct  any  such  tenilencv  that  this  \cnture  in  forecasting  the 
future  is  made. 

Some  i)roblems  have  been  met  and  solved.  Some  diseases  have  been 
eradicated  and  more  are  (-n  the  wa\-  toward  eradication.  Some  diseases 
are  satisfacturiK  under  control  and  some  are  certainly  headed  that  way. 
But  there  will  lie  new  diseses  to  take  the  place  of  some  old  ones.  Some 
diseases  not  now  under  control  nnrst  be  brought  to  heel;  some  diseases 
now  disregarded  must  be  tackled:  the  span  of  human  life  and  efficiency 
must  be  increased:  the  solution  of  new  problems  and  old  problems  long 
neglected  must  be  undertaken. 

The  etfect  which  should  follow  the  reviewing  of  the  battles  of  the  jiast 
is  to  gird  us  for  those  of  the  future.  It  is  hope.l  that  the  Director  of 
Public  Health  in  ]'.•:;;  ean  promote  the  health  of  the  people  and  the  de- 
velopment of  health  departments.  hi>  own  .md  llie  local  de|iartnienls,  with 
even  greater  satisfaction,  than  now  pre\ail>  in  the  mind  of  present  Di- 
rector. 


4()S  SUMMAKV    AND   CONCLUSION 

Till-  I'uriher  (lr\  rliii)iiuiu  iii  cviTy  division  now  in  the  Department 
and  ilu-  inansjuralion  of  several  iu-\\  divisions  can  be  foreJeen  within  the 
next  few  years.  There  must  be  a  dix'ision  to  promote  what  is  sometimes 
erroneously  called  positive  heahh.  Such  a  (Hvision  would  begin  operation 
by  promoting  periodic  ph\sical  examinations  at  lirst  in  large  groups  of  in- 
dustrial workers  which  is  called  closed  groU])s  ;  later  in  more  open  groups 
and  thiallv  among  the  general  population.  In  time  this  division  would 
take  on  such  activities  as  the  promotion  of  winter  sports,  the  promotion  of 
all  sports  regardless  of  season;  the  planning  of  vacations  for  the  renewal  of 
hddilv  vigor;  the  promotion  of  play  for  adults  as  well  as  for  children,  the 
])rnniiitinn  of  some  movement  such  as  the  Turner  and  vcrein  of  Germany 
and  the  Swedish  societies  for  cooperative  physical  development  and  finally, 
the  advancement  of  the  knowledge  and  practice  of  the  rules  of  health.  Such 
a  division  would  have  for  its  motto  "Keep  the  Adult  Well" — parodying 
"Keep  the  Well  Baby  Well" — the  slogan  of  infant-welfare  work. 

Somewhere  in  the  Department,  genetics  will  Ije  undertaken  licfore 
manv  years. 

(!iii<rics. 

The  next  step  will  be  au  increase  in  the  amount  and  \aiiety  of  in- 
formation given  on  the  Ijirth  certificate.  That  <locument  now  gives  some 
information  that  is  valuable  from  the  legal  standpoint.  P'or  the  health 
department  it  serves  to  kicate  the  babies  for  purpose  of  education  and 
training  of  mothers  and  for  statistical  pur])0ses.  It  will  be  enlarged  so  as 
to  give  information  that  is  compar.ible  in  scope  with  that  given  on  the 
death  certificate.  Such  registration  wnuld  contribute  to  a  solution  of  the 
problems  of  |irenalal  care  of  the  parturient  and  of  the  baby  during  the  first 
thirty  da\s  of  life.  The  certificate  will  contain  some  information  which 
can  ser\e   for  studies  in  genetics. 

licsjinitl iirjl  Dis(  uses. 

The  diseases  not  now  engaging  the  ;itteinion  of  the  Department  which 
must  be  studied  and  planned  agamst  are  the  ]ineunionias  and  the  other  respir- 
atory infections  of  the  winter  and  s])ring  such  as  Cdlds  and  bronchitis,  also  ve- 
nereal diseases,  cancer,  heart  disease,  kidney  di.^eises  ;'.nd  rlu-uniatisui. 
Within  ten  vears  we  will  be  approaching  the  time  when  another  great  pan- 
demic "f  inlluenza  is  due,  Ddubtless  the  Health  Department  by  11>3: 
will  ha\r  ;m  outlined  plan  of  cani|iaign  for  repressing  or  at  least  harrow- 
ing this  I'uemy,  which  plan  cumplele  en  general  lines  will  be  in  a  pigeon 
hole   re.aclv    for   use   as   soon    ;is   ihe  disease   appears. 


SUMMARY    AND   CONXLUSION  409 

So  III  I'  Ciiiis'idcratidii  of  DcatJi  Bates. 

At  the  present  time  the  crude  or  uncorrected  death  rate  is  unnatur- 
ally low.  \\'hen  the  calculated  death  rate  hased  on  the  average  age  at 
death  is  compared  with  the  death  rate  as  calculated  on  the  basis  of  re- 
ported population,  the  two  are  found  in  marked  disaccord.  This  is  prin- 
cipally because  of  the  instability  of  the  population,  migration  back  and 
forth  between  counties,  between  the  states  and  between  the  urban  and  rural 
districts.  Industrial  changes  have  come  to  be  large  factors  in  this.  Within  the 
life-time  of  men  now  living  a  good  part  of  this  instability  will  have  ended. 
There  will  be  a  better  accord  between  the  death  rate  indicated  by  the 
average  age  at  death,  the  average  age  of  the  jitipulation  and  the  death 
rate  calculated  on  population.  This  will  nut  mean  a  death  rate  materially 
lower  than  the  present  one.  It  will  mean  the  prevalence  of  one  that  is 
nearer  an  index  of  sanitation,  hygiene,  health  work,  freedom  from  disease, 
bodily  vigor  and  good  heredity  than  the  present  one  is  or  can  lie  corrected 
to  be. 

Old  Age  as  a  Cause  of  Death. 

In  the  earlier  vital  statistics  old  age  was  given  as  a  cause  of  death 
with  great  frequency.  As  employed  in  that  period  the  term  was  loosely 
used  and  it  served  as  a  catch  bag  for  deaths  in  people  fifty  years  of  age 
and  older  from  a  multitude  of  causes.  Because  its  use  prompted  loose 
diagnosis  vital  statisticians  and  health  officers  brought  enough  pressure  to 
cause  its  partial  abandonment.  Before  many  years,  old  age  as  a  cause 
of  death  will  be  used  with  the  approval  of  health  officers  because  it  will 
then  have  a  scientific  meaning. 

Deaths  from  heart  disease,  apoplexy,  Bright's  disease  and  such  occur- 
ring among  old  iieople  will  be  properly  recorded.  The  disorders  due  to 
bacterial  and  other  causes  likewise.  There  will  remain  a  large  number 
of  people  who  will  die  because  of  senility  and  tlu-y  will  lie  pnrperly  classi- 
fied under  that  head. 

Bv  that  time  the  direct  and  the  ultimate  eft'ecls  of  bacterial  infec- 
tions will  be  so  well  understood  and  so  many  nf  these  infections  will  iit 
wiped  out  or  will  be  avoidable  that  the  jimblems  of  senectitude  can  be 
studied. 

Many  of  the  bacterial  disurders  which  now-  threaten  men  will  have 
been  brought  under  contrn].  This  does  not  mean,  bnwever,  that  there  will 
be  none  such.  Even  then  disorders  which  are  endemic  and  mild  in  cer- 
tain regions  will  periodically  break  out  and  swfep  n\er  the  world.  \'ellow 
fever  once  existed  on  this  basis  in  Cuba  and  jieriodicallv  broke  a\\a\-  lo 
sweep  as  a  highh    fatal  disease  (j\er  parts  of  the   L'nited  States.      Inlluenza 


410  SUMMARY    AM)   I'ONCI.USION 

made  a  grrat  swct'p  ovtT  the  world  as  lati-  as  lOlS.     IVriodic  waves  of  dis- 
orders of   the   saiiU'   type  ina\    still   he   expected. 

There  will  l>e  ehaii.i;es  in  vinileiire  of  the  existint,'  haeteria  in  the 
territory  which  the\-  nrniially  inhahit.  And  there  will  lie  new  hacterial 
diseases  esolved  to  lit  new  conditions.  All  in  all  there  is  no  reason  for 
thinking-  that  we  shall  soon  see  an  end  of  the  age-long  strife  between 
man  and  germs. 

I ii(r((isii/>/  SiKiii  (if  Lilc 

Tin-  average  age  at  death  is  said  to  he  ahont  .")S  years  now.  This  is 
interpreted  as  the  average  span  of  human  life.  In  the  pioneer  days  in 
Illinois  few  men  were  over  41)  )ears  of  age.  Men  "lO  years  of  age  were 
regarded  as  old.  It  is  said  that  somewhere  in  that  early  [jeriod.  the  average 
span  of  life  was  about  33  years.  If  men  were  occupied  with  preparation  for 
work  for  twenty  years  only  thirteen  \ears  were  left  for  productive  work. 
When  the  average  span  of  life  is  58  there  are  about  thirty  eight  years  for 
productive  \vork.  Before  long  the  average  span  of  life  should  l)e  at 
least  seventy.  This  would  mean  fifty  years  for  productive  work.  W  hen 
the  average  span  of  life  reaches  seventy  years  there  will  be  large  num- 
bers of  men  and  women  working  i)rotitahly  at  eighty  years  of  age  and  of 
centenarians  there  will  be  many. 

The  State  Department  of  rnblic  Health  has  no  thought  that  the  future 
will  be  free  from  health  problems.  Such  ])rol)lems  will  alwavs  be  present. 
They  will  not  be  those  of  yesteryear,  nor  those  of  today.  The}-  will  be  new 
in  man\  of  their  aspects  but  they  will  be  ini]>ortant  to  the  happiness  of  the 
individual  and  the  welfare  (if  the  State.  When  the  Department  Ijegan 
in  181  7  health  standards  were  low.  An  individual  was  satisfied  with  rather 
poor  health  because  neither  he  nor  his  neighbor  knew  of  the  ]3ossibilities 
of  a  better  standard.  The  ,-anie  w-as  true  in  even  greater  measure  of  collec- 
tive health  called  the  health  of  the  State,  l^iday.  the  standards  of  individual 
and  community  health  are  far  higher.  It  has  been  one  function  of  the  De- 
partmeiit  to  create  reasonable  discinitent  with  low  standards.  This  will 
continue  to  be  one  of  its  functions.  In  time,  health  standards  will  be 
far  higher,  ^len  will  be  discontented  with  conditions  that  now  satisfy. 
Out  of  this,  improveiuent  will  flow.  .\  survey  of  the  past  gives  us  ground 
for  facing  the  future  with  confidence. 


EXECUTIVE  OFFICERS  AND  MEMBERS  OF  STATE  BOARD  OF  HEALTH. 

Presidents.  Date.' 

John  H.  Rauch.  M.  D 1877-1S79  1877 

H.  Wardner,   M.   D 1S79-1SS1  1877 

J.   M.  Gregory,   LL.  D 1881-1884  1877 

Newton  Bateman,  LL.  D 1884-1887  1877 

W.  A.  Haskell.  M.  D 1887-1S93  1881 

John  A.  Vincent,  M.  D 1893-1894  1893 

Wm.  E.  Quine,  M.  D 1894-1896  1893 

B.  M.  Griffith,  M.D 1896-1897  1890 

L.  Adelsberger,  M.  D 1897-1898  1897 

A    C    Corr    M  D                               1898-1899  1898 

C.  b'.  Johnson,  M.  D 1899-1902  1897 

Geo.  W.  Webster.  M.D 1902-1914  1900 

J    A.   Rcbison,   M.  D 1914-1917  1913 


Secretarys. 

E.  W.  Gray*.  M.  D.,  (from  July  to  Dec.) 1877-1877  1877 

John  H.  Ranch,  M.  D.,  Act.   Sec— Dec.  to   May 1877-1878  1877 

Anson   L.   Clark,   M.D 1878-1879  1877 

John  R.   Rauch,   M.  D 1879-1891  1877 

Wm.  R.  MacKenzie,  M.  D Aug.  4  to  Sept.  24,  1891-1891  1883 

F.  W.  Reillv,  M.   D. 1891-1893  1891 

J.  W.  Scott*,  M.D 1893-1897  1893 

J.  A.  Egan,  M.  D 1897-1913  1897 

Amos  Sawyer*,  Act.   Sec 1913-1914  1901 

C.   St.  Clair  Drake,  M.  D 1914-1917  1914 


:>t  the  Board.      Dr.   Egan  h< 


iber  of  the   Board 


Board  Members.  Date.' 

R.    Ludlam,    M.D 1877 

W.  M.  Chambers.  M.  D 1877 

John  McLean,  M.  D 1881 

R.  L.  McCain,  M.D 1SS2 

Wm.  R.   MacKenzie,   M.  D.,  Sec. 

August-September,    1891 1883 

Geo.   N.   Kreider,   M,  D 1884 

A.  W.  H.  Reen,  M.  D 1884 

H.  V.  Ferrell,  M.  D 18S7 

D.  H.  Williams    M.  D 1888 

Geo.    Thilo,    M.D 1893 

Sarah  Hackett  Stevenson,  M.  D..  ..1893 

J.   B.   McFatrich,   M,  D 1893 

Julius    Kohl,    M.D 1893 

Oscar   O.   Haines,   M.D 1895 

D.  R.  Brower,  M.  D 1896 

Florence  W.   Hunt,   M,  D 1897 

P.  H.  Wessel,  M.  D 1897 

M.   Meyerovitz,   M.  D 1897 


Board  Members.  Date.' 

G.  R.  Schater,  M.  D 189fi 

E.   P.   Cook,   M.D 1896 

Z.   D.   French,   M,  D 1897 

C.  H.  Starkel,  M.D 1896 

R.  P.  Bennett,  M.  D 1898 

J.  C.  Sullivan,  M.  D..  . 1901 

W.  Harrison  Hipp,  M.  D 1901 

Wm.   0.   Forbes,   M.D 1901 

Henry  Richings.  M.  D 1902 

R.  E.  Niedringhaus,   M.  D 1905 

W.   R.   Schussler,   M.D 1907 

C.  J.  Boswell,  M.  D 1909 

Adam    Szwajkart,    M.D... 1913 

!  1    Luster,  M,  D 1913 

T.   B.   Lewis,   M.D 1913 

Thos.  O.  Freeman,  M.D 1914 

J.   J.   Hassett,   M.D 1914 

Enos  S.  Spindel,  M.  D 1914 

Felix    Kalacinski,    M.D 1916 


(•ill) 


ILLUSTRATIONS. 

PAGE 

Adult  physical   examination,    Stat.-    l;iii 208 

Annual  appropriation,   1879-192"    207 

rerebro-.spinaI    fever,    meningitis 37C 

Chicago   mortality    rate,    acute   respiratory    diseases,    1870-1910 93 

course  of  the  total  mortality  in  Chicago,   1867,   1SG8 90 

decennial  mortality  rates — all  causes — Chicago,   1S70-1910 94 

mortality   rates — Chicago — 1871-1879,    1922 91.   92 

Diarrhoea  and  Enteritis  In   Illinois 379 

Diphtheria  rates  in  Illinois 360 

Field  laboratory  equipment 259 

Dr.   George  Fisher's  neglected   grave   in  Randolph   County 275 

Health   exhibit  at   fair 227 

Malaria    in    Illinois 3Sl 

Map — typhoid  mortality  in  Illinois 347 

Map — White  County,   Illinois,  on  tuberculosi.s 372 

Map — Yellow  fever  districts   in  Cairo 330 

Number  inspections  all  sanitary   purposes 224 

.Number   investigations  proposed  sewerage   installations 223 

Number  investigations  public  water  supplies 223 

Number    water    analyses 224 

Organization  State  Board  of  Health,  1877 138 

Organization  State  Board  of  Health,  1901 16.t 

Organization  State  Board  of  Health,   1915 177 

Organization  State  Board  of  Health,   1927 199 

Population  served  from  public  water   supplies 229 

rrevalence   of  venereal   disease   in   Illinois 272 

Public   water    supplies   installed 229 

Scarlet   fever   case   reports 350 

Scarlet  fever  deaths  in  Illinois 349 

Seasonal    distribution    of   deaths,    1843-1925 95 

Section  of  main  laboratory  at  Springfield 255 

Smallpox   in    Illinois 308 

State  fair  better  baby  conference   in  action 237 

Tuberculosis    deaths    in    Illinois 362 

Typhoid  fever  deaths  in  Illinois    342 

PHOTOGRAPHS. 

Adelsbers'i',    Dr.    l^oui.s,    Waterloo 176 

Bain,    Dr.    Walter   O.,    Springfield 245 

Bateman,    Newton,    LiL.  D.,    Galesburg 124,  146 

Black,    Dr.    Carl   E.,   Jacksonville 1".  1 1  ■'* 

Brainard,    Dr.    Daniel ■"' 

Bundesen,    Dr.    Herman    N.,    Chicago 203 

Burrill,    Prof.    Thomas   J.,    Urbana 244 

Cadwell,    Dr.    George,    Kaskaskia 126 

Chambers,    Dr.   William   M.,    Charleston 124 

Clark,   Dr.   Anson   L.,   Elgin 124,  140 

Copeland,    Dr.   C.   C    Springfield 26S 

Cook,   Dr.    E.   P.,    Mendota '19 

Corr,   Dr.  A.  C.  Carlinville 1^'^ 

Corr,  Dr.  L.  H.,  Carlinville S7 

Craycroft,  James  Robert,  first   100  per  cent  boy 241 

Cullom,    Governor    Shelby    Moore 128 

Davis,  Dr.   N.  S *" 


(412) 


PHOTOGRAPHS  -ll-> 

PAGE 

Dilly,    Orrin.    Springflelcl 2S1 

Doan,   Dr.    Thomas   D..   Palmyra 203 

Drake,  Dr.   C.   St.   Clair,   Chicago 162,  190 

Drake,    Dr.    Daniel    37 

East,  Dr.  C.  W.,   SprlngHeld 222 

Egan,   Dr.    James   A.,    Chicago 1*2 

Esper,   Gloria  June,   first   100   per   cent   girl 231) 

Evans,  Dr.  William  A.,  Chicago 19",  2»3 

Ferguson,   Harry  F.,   Springfield 222 

Goodbrake,   Dr.   C,   Clinton 40 

Gregory,  John  Milton,   L.Ii.  D.,   Champaign 124,  14G 

Griffith,   Dr.    B.   M.,   Springfield 155 

Haller,   Dr.   F.   B.,   Vandalia 61 

Hamill,  Dr.  Robert  C,  Chicago 66 

Hansen,    Paul,    Chicago 221 

Haskell,   Dr.   W.    A 1S5 

Hemenway,   Dr.    Henry   B.,   Springfield 266 

Howard,    Sheldon    L.,    Springfield 232 

Hoyt,   W.  H.,  Chicago 230 

Hrdlicka,  Dr.  Ales,    (Washington.  D.  C.)    17 

Hull,   Dr.   Thomas  G.,   Springfield    247 

Jewell,   Dr.    J.    S.,    Evanston 41 

Johnson,  Dr.  C.  B.,  Champaign 175 

Kessinger,   Samuel  W.,  Litchfield    267 

Leonard,   Dr.    Thomas   H.,    Springfield '. 220 

Lillie,   Dr.  Charles  W.,   East  St.   Louis i:t7 

Lowden,  Governor  Frank  O.,  Oregon 183 

Ludlam,   Dr.   Reuben,   Chicago ....    124 

MacKenzie,  Dr.  William  R.,  Chester 140 

Mannheimer,   Dr.   Michael,    Chicago 89 

Marquette,   Father    117 

Massie,   Dr.    William.   Edgar   County 53 

McShane,  Dr.  J.   J.,   Springfield 210 

Monroe,  Mrs.  E.  X.,  Quincy 197.  203 

Palmer,  Dr.  George  Thomas,   Springfield 220 

Prince,   Dr.    David,    Jacksonville.  . 75 

Quine,   Dr.    William   E.,   Chicago 15.t 

Rauch,    Dr.    John    H.,    Chicago 124,   140,  14  6 

Rawlings,   Dr.    Isaac   D.,   Chicago 190 

Reilly,   Dr.   Frank  W.,   Chicago 162 

Reynolds,   Dr.   Arthur   R.,   Chicago 313 

Richardson,    Baxter   K.,    Springfield 267 

Robertson,    Dr.    John    Dill,    Chicago 1  :i7 

Robison,   Dr.   John   Albert,   Chicago 175 

Ryan,    Charles,    Springfield 210 

Sawyer,  Amos,  Hillsboro    162 

Scott,    Dr.    John   W.,    Springfield 162 

Searcy,   Earl   B.,   Springfield 266 

Skoog,    Paul    L.,    (California)    243 

Sloan,    Dr.   Edwin   P.,    Bloomington 197,  203 

Small,  Governor  Len,   Kankakee.  ...    4 

Taylor,   Dr.  G.   G..   Chicago 26S 

Vincent,  Dr.  John  A.,  Springfield ' 155 

Wardner,    Dr.    Horace,    Cairo.    124.  146 

Webster,   Dr.   George   W.,    Chicago.  .  .    175 

Woodward.    Dr.    J.    J..     (Washington.    D.    C.) 79 

Wright,    Dr.    John,    Clinton 75 


INDEX. 

PACK 

— A — 

Abel,    Ur.    Theodore    C,    Chicago 25S 

Adelsberger,  Dr.   Louis,  Waterloo 175,   411 

Advisory  Board,  members  of 192,   196,    197,   203,   252 

Ague    2G,   35 

Allen,  Dr.  J debate  on  cholera 45 

American  Bottoms 19,   23,    24,   30,   32,    34,   36,   41 

Amei'ican    colonists   14,   403 

American    Regime,    The 27 

Amoebic  dysentery,  see  Dysentery. 

Anders,   Dr Chicago,   on   typhoid   fever 76 

Andrews,   Dr.   C.   N.,   Rockford 74,   S5,   S7 

Andrews,    Dr.    Edmund,   Chicago 51,   53,   104 

Anemia    30,   33 

Anthrax     244,   252,   257 

Antitoxin  distributed  and   Pasteur   treatments 169,   215,   217,   219 

see    Vaccines. 

Appropriations 133,  135,  137,  13!i,  143,   166,  169,   171,   ISl,   185,   206,  207.   211,  216,   26S 

division  child  hygiene  and   public   health   nursing 235 

communicable    diseases    211 

lodging   house   inspection 165,   265 

sanitary    engineering    223 

tuberculosis    t 220 

vital    statistics    233 

for  State  Board  of  Health 133,   137,    157,    160,    168 

for   State  Department  of  Public   Health 189,206 

graph    on    207 

for  vaccine  farm.   University  of   Illinois 157,   249,   311 

for  water  laboratory.   University   of   Illinois 246 

for  yellow    fever    epidemic 143 

Arnold,    Dr.    Lloyd,    Chicago 25S 

Asthma     18 

Atwater,  Dr.   R.   M 50 

Autumnal    fever    34,   35,   36,   39 

Auxiliary  health  agencies 14,    171.    191,   220,   2S7-303 

— B — 

Baily,    Dr.   F,   K.,    Joliet 69,   85,   86 

Bain,   Dr.   Walter   G.,    Springfield 245,   254 

Baines,   Dr.  Oscar  O.,  Chicago 411 

Barbee,   Dr.   Thomas,   Marshall 67,    6S 

Bartlett,   Dr.  Elisha on   typhoid  fever 71,   73,   76,   77 

Bateman,  Newton,  LL.  D.,  Oalesburg: 124,   125,   137,   146.   153,   411 

Beaumont,    Dr 23 

Bemiss,   Dr.   S.   M.,    (La. ) 143 

Bennett,    Dr.    R.    F.,    Litchfield 411 

Berg,    Elin,    Springfield 10 

Better  baby  conferences 137,   178,   236,    267,   2S9 

Bilious   fevers 32,    35,    3  6,   72 

Births     40S 

and    infant    deaths 113 

rales    19,   23,    29 

registration    drive    in    Illinois 201,   234 

Black,  Dr.  Carl  E.,  Jacksonville 118 

Black,    Dr.    Luther   A.,   Chicago 233 

Black    fly 19 

Black  Hawk  War 17,    31,    43,    102 

Black    tongue    52 

Ulanc,    William     .  .  .  .' 30,   278 


(414) 


INDEX  415 

PAGE 

Blankenmeyei-,   Dr.   H.    C,   Spiingfield 254 

Board  of  Health,  see  State  Board  of  Health. 

Boggess, 30 

Bondurant,   Dr.   Flint 254 

Borendel,    Dr.    F.,    Peoria   County 41 

Boswell,    Dr.   Chas.   J.,   Mounds ■ill 

Boudin,   Dr.,    ,  on  typhoid  fever  and  malaria 78 

Bovine    tuberculosis    369,   374 

Bowen,   Dr Joliet 39 

Brainard,    Dr.    Daniel 47,   48 

Breast    feeding    demonstration 240 

Breed,   Dr Princeton SO 

Breen,    Clara,    Springfield 2,    10 

Brennan,  Dr.  Earl,  East  St.   Louis 25S 

Bridges,   Dr.   T.   B.,   Chicago 104 

British    Regime,    The 13,   26,   28 

Bronchitis 65,    90.    109,   408 

Brower,   Dr.   Daniel   R.,   Chicago 411 

Buhlig,  Mrs.  Blanche,  Chicago,   committee  on   child   hygiene 242 

Bundesen,   Dr.   Herman  N.,   Chicago 203,   272 

Burns,    Dr Mackinaw 38 

Burrill,   Prof.   Thomas   J.,   Urbana 244,249 

Butler,    Jlajor,    (Washington,   D.   C. )    on   dt-ntal    hygiene 242 

— C — 

Cadwell.    Dr.    George,   Kaskaskia ,. 126,   130 

Cahokia     .' 23.    32,    34 

Cairo    32,    141,    172,    212,    377-338 

Cancer    17,    298,    305,   408 

Carr,   Clark   E.,    (1S50) 43 

Carroll,  Dr ,   on  typhoid  fever.  .  .  .  .' 76 

Cassiday,    Hugh,    Springfleld 252 

Catlin,  Dr.   George 38,   49 

Cerebrospinal   fever    64,   375 

graph    on     376 

Chamberlain,   Dr Kane   County 42 

Chambers,  Dr.  William  jr.,  Charleston 124,  125,  137,  279,   396,   411 

biography    of    125 

Chancroid,  see  venereal  diseases. 

Chapman,    Dr.    H.    W.,    Whitehall 85 

Cheneoweth,  Dr.  W.  J.,  Decatur 86 

Chicago,  chronicle  health  and  sanitation  in ., 101—114 

fire    (1S71)     106 

DeWolf,   Dr.   Oscar   C 105,323 

drainage  canal,   sewage  from 168,   245 

Evans,  Dr.  W.  A 2,   196.   197,   203.   272.   291,   294,   302,   369 

health  department 43,   44,   47,    50,   S9,   247.   250,   261,   405 

annual    reports    of 87,   105 

Health  history  prior  to   1877 101-114 

Mannheimer,    Dr.    Michael,    charts   by 89 

milk     300,301 

prohibiting  sale  of  from  tuberculous  cattle 369 

Ranch,   Dr.   John  H.,  appointed  sanitary   superintendent 105,   106,   107 

Reynolds.  Dr.  Arthur  R 105.    166.   313 

Statistics 50,  51,  S3,   87,   89.   90,   99,   102,   103,   104.   106.   107-114,  313,   320,   397 

annual    death    rates    (1843-1877) 107 

consumption     Ill 

diphtheria    109,   354.   356 

erysipelas    114 

malaria     113 

measles    112 

pneumonia    110 

respiratory    diseases    110 


4:16  INDEX- 

PAGE 

Chicago,   chrdiiuk-   lu-:iUli   ami   sanitation   in — Concluded. 

scarlet    fever    103,   lOi),   348 

smallpox    Ill 

typhoid   fever S3,    108,   16G,   33i).   340.   351 

whooping    cough    112 

annual   reports  of,  deaths  all  ages 87,   il9 

deaths    under    1 1)9 

deaths    under    5 87,  89 

first  death   rates   from 83 

graphs    on    , 89 

survey,    tuberculosis    370 

Will  you  become  a  crusader,  chart 369 

Chi.kenpox     253,   374 

investigation   every  reported  case  of 202,   312 

Chills    31,    32,    35,    38,   78 

see  Malaria. 

Chirac    (1742)    on    typhoid   fever 71 

Cholera    ■  •  •  • 

9,  17,  31,  53.  70,  78,  S4,  S5,  103,  105,  127,  136,  139.  141.  244.  305.  339.  353,  363,   383,   400 

death  of  Governor  Ninian  Edwards  from 44 

debates   on    45 

epidemics    in    Illinois • 321-327 

infantum     86,    104,   106 

morbus 72,   86,   104 

pandemics   of   43 

prohibit    transportation    of    bodies    dead    from 150 

rules  and   regulations    for   control   of 150 

Civil  Administrative  Code,  adoption  of 134,   135.   182,   1U2,   207,  211,   225 

powers   and    duties   under '. 184 

Clark,  Dr.  Anson  L,,  Elgin 124,    125,   137,   139,   140,    153,   411 

biography    of    125 

Clark,    George    Rogers 13.    14 

Clay.    Dr.   A.    J..    Hoopeston 67.   68 

Colburn.    Dr Bloomington 3  6.   52 

Coleman,    Dr.   J.   W.,    LeRoy 85 

Colonial    pei-iod    28 

Communicable    diseases,    rules    and    regulations    concerning 

132,    148,    150,    156,    ISO,    185,210 

curative   measures    for 166 

Consumption IS,    19.    20,   24,   32,   41,   60,    97.    404 

annual  death  rate    from,    in   Chicago llo 

Cook,  Dr.  K.   P..  Mendota 49,   69,   75,   76,   80,   86,   249,   411 

Cook,   Dr.    P.    M.,    Chicago 44 

Cook,   Dr.    Robert   C,    Springfield 235 

Coolidge,   Dr (Washington,   D.   C.) 64 

Copelan,  Dr.  C.  C.  Springfield 268 

Corr,    Dr.    A.    C,    Carlinville 175,411 

Corr,   Dr.    Lucinda    H..    Carlinville 87.   88 

County    health    departments 195.   196.    198,   257 

deCourey.    Dr.   .lames,   assigned   to   Cairo 336 

Crawford.    Dr on    typhoid    fever 74,   75,   76 

CrawforO.    1  ir.    ('litis    !•:.,    Koekford 211 

Crippled    rhildren's    cliliii-s    ilisciintinued 199.   235.    380,    406 

Croghan 26 

Crothers.   Dr Bloomington 64 

Crowley.    Dr.    W.    .S 252 

Cullom,    Governor    Shelby    Moore,    Springfield.    128,   280 

Cunningham,  Dr.    V\'.  H..   Rockford 25s 

Cynanche.  death  of  George  Washington  caused  by 55 


Pappert.    A.    F..    Springfielil 2 

Davis.  Dr.  X.  S 40,   4.t.  .")L>,   o7.  70.   74,  7fi.   8.5,  SS,  3SS 

debate    on    cholera    .    45 

Dawson,    Dr on    typhoid    fever 70 

Deaths,  see  Mortality 

deLiesseps 2n 

Deneen,    Governor    Charles    S.,    Chicago    169 

Dengue,  pandenic  of 4fi 

Dental    demonstrations    200.  242 

Development  of  State   health   service 133 

three  periods 133,   13S,    16.t,    177,  199 

four    personalities    134 

DeWoIf.  Dr.  Oscar  C.  Chicago 103,  323 

Diarrhoeal  infections    14,   IS,  20,  21,  25,  30,  41,  72,  81,   85,  90,  305,  377,  398,  403 

among     Indians     - S3 

annual    death    rates,    Chicago 104,    IDS,  354 

in   adults    84,   86 

infant   mortality   due    especially    to S6— S8 

mortality    from     377 

graph    on     379 

Dickinson,    Dr Peoria 39 

Dickson,  Dr.  S.   H on  typhoid  fever 79 

Diehl,   Dr.   C.   H.,   Effingham 29  6 

Dilly,     Orrin,    Springfield 231,233 

Diphtheria    9,   96,   136,   IGS,   247,   250,   253,   304,  3S3 

among    Indians     55 

Annual    death    rate.s,    Chicago 104,    108,  354 

cases    of    357 

carriers    , 358 

distribution  of  antitoxin  for 216,    217,   244,    353,  401 

mortality   from    353,   357,  360 

graph    on     360 

outbreak   at   Rock    Island    259.  260 

phenomenal    progress   in   eradication   of 3{  6 

prohibit    transportation    bodies    dead    from 150 

rules  and  regulations  for  control  of 150 

Directors,   State  Department  of  Public  Health 182,  190 

Division  of  child  hygiene  and  public  health   nursing 189,    199,  231 

committee  on  child  health  needs  in  Illinois 200,  242 

of  communicable    diseases     185,  210 

of  general    oflice    185,  209 

of  laboratories,   biological  and   research 189,  247 

diagnostic    , 181,   186,   193,   245,  247 

of  lodging    house    inspection 164,   171,   173,   186,  265 

of  public  health   ins  ruction 189,   192.  286 

of  sanitation    185,    221,    243,    247,  381 

of  social    hygiene    188,    247,  268 

of  surveys    and    rural    hygiene 189,   206,  243 

of  tuberculosis     185,  220 

of  vital    statistics    186,   230,  254 

Doan,   Dr.    Thomas   D.,    Palmyra 203 

Doane.    Dr.    Phillip    S.,   Chicago 334 

Drainage,    see   American    Bottoms 

Drake,    Dr.    C.    St.    Clair,    Chicago 135,    162,   225,  411 

appropriations    under       191 

biography   of    1 9(i 

regime    135,   174-194 

Drake,  Dr.   Daniel 19,   36,  37,  38.  39.   43,  47,   52,   54,  57,  60,   64,   67,   6S,   73,   78,   S4,  397 


41 S  INDEX 

I'AUK 

Dropsy     IS 

Driide,    Dr.    Francis.   Quincy 33 

Dunne,    Govermir    lOdward    F.,    Chicago 174,  181 

Dupray,    Martin    .    254 

Dysentery   '.I,  14,  IS,  20,  21,  2r..  2S,  30,  72,  78,  86,  lis,  IGS 

annual  deaths  and  rates  in  Chicago 104,  114 

mortality    from     84 

Dyspepsia    57 

— E — 

East,    Dr.    C.    AV.,    Springfield 1S7,   211,  2:!4 

lidgar,   rapt.   I.  D.,    (Washington,   D.   C.) .«4 

Edgar,  Dr.  W.  S. debate  on  cholera 45 

Educational    propaganda    ...    135,   176.  206 

Edwards,    Governor   Xinian,   death    from   cholera 44,  129 

Egan,  Dr.  James  A.,  Chicago 78,   177,   232,   253,   336,   337,  411 

appropriations    under    135 

regime     134,   159-174 

Egyptian  mummies    21,   5» 

Ellis,   Dr.   C.   C,    Moline 233 

Embalmers,    law   passed   regulating    practice 2S5 

English,    Dr Jacksonville 3S 

Epizootic,  horses  died  from  in  Chicago lOG 

Krasmus.  scientist,  on  t.vpho'd  fever 72 

Ergot    paralysis    64 

Erysipelas    50,    52,    54,    65,    104,    1C.5,  4I12 

annual    death   rates  in   Chicago 114 

Evans.   Dr.   Wm.    A..   Chicago 2,    1!16,    197,    203,    272,    2!)1,    294,    302,  369 

Exhibits     135,   176,   178,   206,  267 

Eye    troubles    33 

— F — 

Fancher,   Homer  C,   Chica.i^o 1*14.  265 

Faught,    Eva   E.,    Carbondale 252,   25S,  263 

Felder,   Dr,  W.   Ij ,  on  fevers 78 

Ferguson,   Harry   F.,   Springfield 222 

Ferrell,   Dr.   H.   V.,  Carterville 411 

Fisher,    Dr.    George,    Kaskaskia 130,   273,  275 

Fitch.   Dr (Ind.)    52 

Flagg.    Dr Edwardsville 32 

Flint,   Dr.  Austin on   typhoid   fever  and   malaria 7S 

Fluxes     18,   S6 

Food  poisoning 81,   24(1,  257 

Forbes,    Dr.    Wni.    ().,    Chicago 411 

Fordham,    Dr (England) 32 

Forry,  Dr.    .  .' (Washington,  D.  C.) 64,   102,  397 

Fort    Cbartres    26,   34 

Foreword     9 

Foster,   Dr.   I.   H.,  Chicago 211,  371 

Freeman,    Dr.    Thomas    O.,    Maitoon 411 

French-Canadian   Regime,  The 13.   15.  22.   28,   29,   49.  53,   39S,  403 

French,    Dr.    A.    W.,    Springfield 115 

French,   Dr.   Z.    D.,    Lawrenceville 411 

Fruterrer.    Dr.    Oustav,    Chicago 245 

Fry,    Luella,    Springfield 253 

Frye.  Dr.  J.  C.  Peoria 38,   39 

Fults.    Dr.    J.    C,    Waterloo 335 

— G — 

Callhrieth.    Dr un    pui-rp.ral    fever 65 

(landr.lphr,    Tir.    .Mi.hel mi   ..ligin  of  syphilis 59 


INDEX  419 

PAGE 

Ganott,   Dr.   Erasmus,  Chicago 315 

Gates,   Dr.   JoseiJh,    Marine 68 

Gehrmann,    Dr.    Adolph,    Chicago 247 

General  health  history  prior  to  1S77 15 

Genesis  of  public  health  law 127 

Genetics     408 

Gerhard,  Dr (Penn.)   on  typhoid  fever 71,   73 

Gerhard,    Dr.    Frederick,    Chicago 41,   61 

Gilchrist,  Dr.    (1735)   on  typhoid  fever 71 

Gilmore,  Dr.  "W.  H..  Mt.  Vernon 257 

Glackin,    Senator   Edward   J.,   Chicago 179,   220,   291,  366 

law  for  tuberculosis  sanatoria 163,  172,  179,   365,   368,  371 

Godfrey,  Dr.  E.  S.,   (Xew  York) 211 

Goitre  sufvey    242 

Gonorrhea    ^ -'-'.   24.   60,   254,   270,   298 

Goodbrake,    Dr.    C,    Clinton 40,   85 

Goodell,    Dr.   W.   L.,    Effingham 86 

Gorgas,    General   William   Crawford 25 

Gout     18 

Graphs,  see  Illustrations 

Graves,  Dr.  X.  A  ,  Chicago 293 

Gray,  Dr Jefferson  County 57 

Gray,  Dr.  Elias  \V.,  Bloomington 130,  131.  132,   137,  139,   HO,   411 

Gray,    Dr.    Ethan    A.,    Chicago 368 

Gregory,   Dr.    John    Milton,    Champaign ' 124,  125,   137,    146,   411 

biography  of    125 

Griffiths,    Dr.    B.    M.,    Springfield 153,155,411 

Griflitts,  Dr.  T.  H.  D 233 

Grinstead,    Dr.    W.    F.,    Cairo 334 

Guiteras,    Dr.    John    (.Ala.) 335 

Gumston,  Dr.  C.  G on   typhoid  fever 70 

— H — 

Haines.   James    31,   43 

Hale,    on   unity   of   fevers 73 

Hall.   Dr.   L, ,   Kane   County 40 

Hall.   Dr.    Thomas.    Toulon 64,    84,   85 

Haller.   Dr.    F.   B.,   Vandalia 40,   61,   118 

Hammill,  Dr.  Robert  C,  Chicago 33.  53.  61,  66,  89 

Hamilton,   Dr.   John  B.,  Chicago 335 

Hamtranmck,   Major 26 

Harmon,    General   J 26 

Hansen,    Paul,    Chicago 221 

Harris,   Dr.  J.   O..   Ottawa 87 

Haskell.  Dr.  W.  A.,  Alton 153,   155,   411 

Hassett,    Dr.    J.    J.,    McLeansboro 411 

HauU,   Dr on   puerperal    fever 66 

Health   conditions   in   Illinois  after   1S77 304 

promotion   week    135,   179,   294 

Heart    disease    305,   408,   409 

Hemenway,  Dr.  H.  B..  Springfield 266 

Menkes,    Kirby,    Springfield    252 

Hennepin,   Dr on   milk   sickness -. 67 

Henry,    Dr Springfield 38 

Henry,  Dr.  Alexander 18,   19 

Henry,  Dr.    J.    F.,    Bloomington 36,   52 

Hepatites,   chronic    57 

Hewins.   Dr.   L.    T.,    Loda 46,   86 

Hildreth.  Dr.  S.  P.,  (Ohio) 33,   65 

Hipp,  Dr.  W.  Harrison,  Chicago 411 


420  INDEX 

PACE 

Hiisch,  Dr 43.    14.   47.   49,  50,   55.  56.   57.  63,  64,  65,  71,   7S 

History   of   certain   diseases   prior    to    1S77 35 

after    1S77     304 

steps  in   establishment   of  typhoid  fever  as  a   specific  disease 70 

Hoffman,    (1728)    on  typhoid  fever 71 

Hoffman,    J3r.    T.    A..    Heanl.stown 41 

Holder.    A.    H 19 

Hollister,    Uv.   .1.    H.,   on    niir.sing   sore  mo\ith '69 

Holmes.    Dr.    Oliver    Wiiulcll ..43,   66,   73,   74 

Holmes,    Dr.    \V.    H 254 

Holsten.   Dr ,    on   puerperal    fever 65 

Howard.    Shehinn    b .    SpriMSfiekl 232 

Howland,    Dr Ottawa 39 

Hoyt,    W.    H.,    Chicago 20S,   232,   233,   253 

Hrdlicka,  Dr.  Ales,   (Washington,  D.  C.) 17,  IS,  1!),  20,  49,   53,  55,  58,   60 

Hubbard,    Gordon    S.,    Chicago 22.   23,   102 

Hull,    Thomas    G.    Springfield 247,   252 

Hunter.   Dr.    I.    \V..  on  origin  of  syphilis 60 

Hunt,    Dr,    Florence    W.,    Chicago 411 

HurUiert,    Dr Ottawa 39 

Huxhaiu    (17S4)    on    typhoid    fever 71,   72 

— 1 — 

Ilkemire,  Dr.  J.  A..  Palestine 258 

Illinois   and    Michigan   Canal 40,    42,    101,   106 

Illinois  Medical    Society   formed 39 

debates    on    cholera 45 

Immigrants    29,  35,  47,  66,  101,  136,  142,   147,   154,   172 

measles  brought  in   by    54 

smallpox  carried   by    50 

Indians    13,   15,   17,   19,   21,    39,   53,   39S 

diarrhoea!    diseases    among S3 

high    death    and    low    birth    rates 29 

smtillpox,  disease  of 49 

syphilis    among     58 

Indigestion     IS 

Infantile    paralysis    187,   234,   370,   379 

clinics    for 199,   235,   3S0,   406 

table    on    3S0 

Infant  mortality    19,  30,   S6-8S,  242,  393,   403 

among    Indians    19 

annual   death  rates   in   Chicago 113 

detailed   rates  on    201 

Infants,   diseases  among      14 

Influenza   90,  96,  191,  404.  40S 

and  pneumonia,  epidemics  of 62 

mortality    from    in    Chicago 109 

Ingals.  Dr.  E debate  on  cholera 45 

Intermittent  fever   26,  35,   36,   40,  72,    78 

annual  death  rates,  Chicago 113 

Intra-departmental    organization     208-272 

Introduction      13 


Isthmus    of    I": 


on    unity   of   fe 
Jayne,  Dr Springfield. 


Jenner,   Dr.    Edward,    (England) .  .    320 

Jenner,  Sir  U.,    (1849)    (England),  on  unity  of  fevers 72 

Jesui's     24.   32,   42 

Jewell,    Dr.    .1.    S..    iOvanston 41,   70 


INDEX  421 

PAGE 

Johnson.   Dr.  C.   B..  Champaign 42.  .->5.   64,   SO,   82,   17.">,  390,  411 

Johnson,    Dr.    Hosmer   A.,    Chicago 10.5,  143 

debate    on    cholera 45 

Jonas,    M.    M.,    Chicago 1C4 

Jones,  Dr Jacksonville 3S 

Jones,   Dr.    H.   W..   Chicago    66 

Jones,  Dr.   Joseph,    (Ohio  Valley) .").S 

— K — 

Kalacinski,    Dr.    Felix,    Chicago 411 

Kaskaskia     23,   26,   32,   34,   273,  277 

bottoms     115.  lis 

removal  of  capital  from ^ US 

survey  of  prior  to  3  877 116 

Kessinger,    Samuel    W.,    Litchfield 267 

Klebs,   Dr.    A.    C,    Chicago 2S0,  293 

Koch discovery  of  anthrax  and  tuberculosis   bacillus   by 244,  364 

Koehler.    Dr.    C.ottfried,    Chicago 2,  102 

Kohl,    Dr.    Julius,    Belleville    411 

Kramer on    origin   of   syphilis .59 

Kreider,    Dr.    George    X.,    Springlield 411 

— I. — 

Laboratoi-ies,    branch    258 

certificates   of   approval    for 262 

diagnostic,  biological  and  research 1S6,   1S9,   193,   247,   24S,  254 

examination   of  water  supplies 244 

equipped    tor   making   diagnostic   examinations 166,    173,  ISl 

investigations    conducted    by 252 

total   examinations,    table   on 256 

LaFeve French   trader 39 

Lakes   and    ponds,    stagnant 34 

Lancise    (171S)    on   typhoid   fever 71 

Laub,   Wm.   G.,   Chicago 265 

Leasure,  Dr (Penn. )   on  puerperal  fever 65 

LeBlanc,    on    malaria 25 

Legi-slation 129,   130,   132,   133,    198,   215,   24S,   311,  404 

important  health  laws  enacted 179,   214,   216,   271,   272,  374 

medical    practice    acts 273—286 

organization   of  State   Board   of   Health 127,    137,  404 

regulating    practice    osteopathy 284 

requiring   pasteurization   of   milk 204 

Leonard,    Dr.   Thomas   H..    Springfield 220 

Lewis,    Arch,    Chicago 265 

Lewis,  Dr.  T.  B.,  Hammond 411 

Liller,  Dr.  J.   (',.,  Woodford  County 41 

Lillie,  Dr.  Charles  \V.,  East  St.   Louis 196,  197 

Lincoln,    Abraham    67,    115,  137 

Lincoln,  Nancy   Hanks,  death   from   milk   sickness 67 

Lister,    Lord,    (England) 131,  244 

Local  boards  of  health,   creation  of 172,  1S9 

attempts    to    improve 196 

Local  health  district  and  law  providing  for  establishment  of 179,  215 

Lodging    house    inspection 171,   173,  208 

act   creating    164 

chart   on    165 

Long,  Dr.  Esmond  H on  consumption  among  Puritan   fathers 20 

Long,   Prof.   John   H.,   Chicago 245 

Lortel on    origin   of   syphilis 59 

Lot.ery,  see  American   Bottoms 

Louis    (1829),   treatise  on   typhoid   fever 20,   70,   71,   73,   75 


422  INDEX 

PAGE 

Lovvden,    Oovcrnor    Frank    t).,    Oregon 135,    179,   182,   183 

Lowry,   Dr.   Kdith  H.,   St.   Charles 236 

Ludlam,    Dr.    Reuben,    Chicago 124,   137,    153,   411 

biography  of   125 

Luster,    Dr.     R.    D.,    Granite    City 411 

— M — 

MacCulIiK-li,  .IcliM    (1S2!1)    35 

MacKenzie,  Dr.  Wni.  R.,  Chester 140,    152.   153,   411 

Malaria    

9,  13,  19,  20,  21,  24,  25,  26.  28,  30,  33.  39,    12.  47,  73.  74.  77.  78.  84.  90.   118,   l(i8,   254,    399 

and  typhoid   fever    69-83 

annual    death    rates   in    Chicago 104,   113 

cases    of    382 

French  no  immunity  to 25 

history   of  prior   to   1877 35 

mortality    and    rates 382 

graph    on     381 

noticeable  decline   in    304 

Mann,   A.   H.,   Springfield,   inspector  at   Cairo 334 

Mannheimer,   Dr.   Michael.  Chicago,   concerning   charts  by 89,    105 

Manse,    Dr.    Hiram,    Lafayette 87 

Marquette,    Father     IS,   23,    42.   S3.   117 

Marriages     13.   23,   26,   397 

Massie,    Dr.   Wm.,    Grand    View 53 

Maternity    and   child   hygiene 199,    238 

advisory  committee   on    200 

Sheppard-Tovvner   Act    200,   238 

Matthews,   Dr.   J.   P.,   Carlinville 85 

McCain,   Dr.   R.  L 411 

McClanahan,   Dr.   B.  V.,  Galesburg,  committee  on  child  hygiene 242 

McCulloch,   W.   W.,   Chicago 265 

McFatrich.  Dr.  J.  B.,  Chicago 411 

McGarragh,   Dr ,  on  milk   sickness 68 

Mcllvaine,   Dr.   T.   M.,   Peoria 150 

Mcintosh,    Dr.    Donal,    Urbana 249 

McLaughlin,   Dr.   R.   G.,   Heyworth 85 

McLean,    Dr.    John.    Pullman 411 

McShane.   Dr.   John   .1.,   Springfield 210-219 

McVey,   Dr Morgan    l^>unty 53.    57 

Measles 33.    96,    366.    374.    383.   402 

annual  death   rates  in   riiicuRo 104,   112 

brought    in   by    iiuniigiants 54 

cases    of    385 

Medical    examination   of   school   children 238 

Practice  Act,  The 127,   130,   132,   156,   159.   273 

acts  of   1817,   1819,   1877 273-286 

divorced  public  health  service  and  I'cgulation  of 182 

minimuin   retiuirements    282 

standards   for   medical    education 281 

Meeker,    Dr ,    Chicago 52 

Members,   State  Board  of  Healt^h 124,    137,   411 

biographies     125,   137,   190 

Menard,    Pierre, ^TCaskaskia 273,   276 

Meningeal    fever    57 

Meningitis    56.    64,    375,   403 

graph    on     376 

Merriman.    Dr ,    Springfield 38 

Mettaurer,   Dr ,    (Va.)    on   fevers 7S 

Meyerovitz,    Dr.    M.,    Chicago 411 

Midwives,    certificates    to    practice    required 2S5 


INDEX  423 

PACK 

.Milk 164,   ISl,   202,   204,    227,   2.52,   257,   260,   301,   342,    350,    369 

niudel    ordinance    for 202,   204 

pasteurization  of    202,   226,   260,   395 

sickness     66,   S4,    400 

mortality    from    67 

prevalence    of    66 

Miller,   Dr.  Ben  S.,   Chicago,  appointed   .'ianilary   .supeiintendent 106 

Missionaries    13,   22 

Mitchell,   Dr.   R.   W.,    (Tenn.) 143 

Model   milk  ordinance  adopted 202,   204 

Modern    health    crusade 290,   294 

Modified    Quarantine    213 

Monette,    Dr.    J.    W.,    (Miss.) 73 

Monroe,  Mrs.   E.   N.,  Quincy 19(1,   197.   203 

Morbidity,   decrease  in   summer  sickness   rates 404 

general   unhealthfulness    , 29,   39S 

see  various  diseases. 

Morg-an,    (176S),    on   ague   and    fever 26 

Morgaginni    (1761)    on    typhoid    fever 71 

Mortality    25,    62,    202,    230,   234 

all     causes 96,   97 

certain  causes,   Illinois  and  Chicago,   tables  on 96,   304 

children   under   5    years,    table   on 88,    89 

cholera      43-46 

diarrhoeal    infections    377,   378 

diphtheria 55,     IDS,   353 

increasing   span   of    life 410 

infant 19,    30,    86,    113,    201,    242.    393,    394,    395,   403 

measles     43,   385 

milk    sickness 67 

pneumonia   and    influenza 62,   388 

population  and  number  deaths,   tables  on 98—100 

rates    29,    304,    398,   409 

all  causes 96,    343,    351,    354.   364 

annual,    certain    diseases 107 

infant .    394 

Springfield     116 

tuberculosis    364 

typhoid    fever 108 

see  Chicago  statistics 

scarlet    fever 351 

smallpox    310 

tuberculosis    361 

typhoid    fever 82,    108,   338 

see   illustrations,   Chicago   statistics 

Mosquitoes 19,    25,    35,    36,    46,    101,    381,   400 

Mound    builders    13,    15,   58 

Murchison,    Dr.   Chas.    (1862)    on    typhoid    fever 71,   339 

Murphy,   Dr.   J.,   Peoria ! 39,   87 

— N — 

Nance,    Dr Lafayette 53 

Nauss,    Dr.    Ralph    W 252 

Neely,   Dr.   John   B.,   Chicago 334 

Nelson,   Dr.   C.    S.,    Springfield 211,335 

Neuralgias    57 

Niedringhaus,    Dr.    R.    E.,    Uranite    City 411 

Noble,    Dr.    Harrison,    Bloomington 61,   70 

Notthaft (Cermany)    on    origin    of    syphilis 59 

Nursing    service 230 

Nursing  sore  mouth 69 


451  INDF.X 

PAGE 

— o— 

Olson,   Dr.   (_'.    \V.,    I, ..ml. aid 364 

Ophthiilmiu    neonatoitnii 33,  289 

epideniif     ^'^ 

Osborne.   Governor  Chase    (Xrii-h.) ^1 

Osier,    Dr.   Wm "•• 

Outbreak  of  yellow   fever  starts  machinery   for  control  of  epidemics 141 

Owen,    Dr.    Dale,    (Ind.) 6S 

Oysters,    typhoid    fever   .-ittributed    to 204,    214,    257,  34C 

— P — 

Palmer,    Prof.    Arthur    Wra.,    Urbana 221,  246 

Palmer,   Dr.   George  Thomas,   Springfield 1 S5,   220,    .■!36,  371 

Panama    canal,    deaths    in 25 

Paralysis,    ergot 6* 

Parkman IS,   23 

Parran,   Dr.   Thomas,   .Ir.,    (Washington,   D.   C.) 198 

Parrish,     Randall 44 

Pasteurization,   law   passed    re(iuiring 202 

milk   supplies 164,    ISl,    260,    301,    342,    350,  395 

Pasteur (France) 131,    169,  244 

Payne,  Dr.   H.  R.,  Marshall 40 

"Petechial  fever"    (typhoid) 70 

Petit    (1814)    on    typhoid    fever 71 

von  Pettenkofer,   JIa.x,    (Germany) 105,   114,   131,   137,  339 

Pettit,   Dr.   J.   W.,   Ottawa 293 

Pettit,   Dr.   Roswell   T.,   Ottawa 258 

Phillips,   Dr.   G.   W.,   Dixon 61 

Physical   examinations,   annual 206,    242,  298 

scientific   examination    of   returned   soldiers 373 

Pickett (Ala.) 13 

Pierce,  Dr.  C.  ("..    I  Wasbiiiut.in.   D.   ('. ) 272 

Plague    400 

Pleurisy     33,  109 

Pneumonia 19,   20,   25,    30,   33,    62,   96,    387,    398,  404 

and    influenza •  -  •  62 

annual   death   rates   in  Ghicag.. 109 

cases    of .* 3  8  S 

graph  on 389 

Poles,    in    Illinois , 28 

Poliomyelitis,   see    infantile   paralysis 

Ponds  and   lakes,   stagnant 3  4 

Population   of    Illinois,    increase    in 100 

and  number  of  deaths,   tables  on 9S 

Powers  and  duties,  under  State  Board  of  Health  Act 184 

under  ophthalmia  neonatorum  act 185 

under  vital    statistics  act 184 

under  miscellaneous    acts 185 

Preface     7 

Presidents,   State  Board  of   Health 146,   155,    175,  411 

Prince,    Dr.    David,    Jacksonville 75 

debate  on  cholera 45 

Prosser,  Dr Jacksonville 38 

Prost,    (1804),   on   typhoid    fever 71 

Public   health  administration    in   Illinois 127-272 

intra-departmental    organization 208-272 

Puerperal    fever 50,    51,    53,    54,    74,    202,  402 

epidemic    of 65 

Puritan    fathers,   suffered    from   i.insumption 20 

"Putrid     fever" 53 


IXDEX  425 

PAGE 

— Q— 

Quaife     31.    102 

Quarantine,  during:  yellow  fever  epidemic 142,  327,   3:i0 

modified     213 

rules  and  regulations  pertaining  to 132,   150,   180,   210,   212 

yellow   fever  committee   appointed 143,   334 

Quine,   Dr.   W.   E.,   Chicago G6,    150.   411 

Quinine     42,   77 

— R — 

Rahie.s 215,    251,    253,   256 

vaccine     for 219 

Ranch,  Dr.  John  H.,  Chicago 

102,   105,   106.   107,   124,  125,   131,  231,  266,  2S0,   303,  339,  396,    411 

appropriations    under 137,    139,    141 

biography    of 125 

general    State   sanitary    survey ■. 147,    198,   339 

regime    134,    139-159 

resignation   of 153 

yellow  fever  outbreak  at  Cairo 141,   327 

Rawlings,  Dr.   Isaac  D.,  Chicago 2,    161,    190,    312,   407 

advisory  board  appointed 196,    197,   203 

appropriations    under 206 

biography    of 190 

regime     135,   194 

Raymond,    (1911)   scientist,  on  origin  of  syphilis 59 

Reed,     Dr.     Silas 63,   86 

Reen,  Dr.  A.  W.  H..  Peoria 411 

Reeves,  Dr.  J.  E.,   (Va.) 70 

Regime,  American,   The 27 

British,    The 26,   28 

Drake,    The 135,    174-194 

Egan,   The 134,    159-174 

French-Canadian.    The 13,    15,    22,    28,    29,   53 

Rauch,   The 134,   139-159 

Rawlings,    The 135,   194 

Reilly,  Dr.  Frank  W.,  Chicago 105,   152,   156,    162,  315,   332,   396,   411 

Respiratory    diseases 110,   408 

Reyburn,    (1856)   on   fevers 75 

Reynolds,    Dr.    Arthur    R.,    Chicago 105,   166 

article    by 313 

Reynolds,   Governor   John,   Belleville 32,   67 

Rheumatism 21,   25,   33,    50,   398,   408 

Richardson,    B.    K.,    Springfield 2,    243,   267 

Richings,  Dr.   Henry,  Rockford 411 

Ridley,    Dr ,   on   puerperal    fever 65 

Ringland,   Dr.   Geo ,   on   epidemic   of   dysentery i S6 

Robertson,   Dr.   John   Dill,  Chicago 196,   197,   370 

Robison,    Di".    John    Albert,    Chicago 175,   411 

Robson,   Dr.    R.,    (Ind.) 39 

Roe,   Dr.   Edward,  Blooniington 70 

Ross,  Alexander l.S,    59,    381 

Rouse,    Dr I'eoria 39 

Rowe,   John    (1838)    on   milk   sickness 6S 

Rush,    Dr.    Benjamin,    Chicago 71,    72,    73,   74 

Ryan,    Charles,    Springfield 210 

— S — 

Sachs,   Dr.   T.   B.,   Chicago 366 

Sadler,  Dr.  Lena  K.,  Chicago,  committee  on  child  hygiene 242 

Sandburg,     Carl 36 

Sanitation,    provisions    relating    to ■.132.    139,   221 

stream    pr.llution,    invcsliga  I  inns    ..r 163.    172 


426  INDEX 

I'AGK 

Sawyer,   Amos.   Hillsboro 162,    174,    21U.  411 

Scarlet   fever 17,   33,   50,   55,   ^ti,   .136,   253,   348,   366,    3.S3,  4IJ1 

among:    Indians 53 

annual  death   rates  in  Chicagro 109 

c:ase     reports 350 

epidemic  of  in  Chicagro 103,  106 

mortality    from 351 

grapli     on 349 

Scrofula     19,   60 

Scurvy     69 

Searcy,   Earl   B.,   Springfield 266 

Seasonal   distribution   of   disease S9 

Secretaries,    State   Board    of   Health..: 140,    162,  411 

Senility,  as  a  cause  of  death 409 

Serres  (1S14)   on  typhoid  fever 71 

Sewerage  in  City  of  Chicago,  prior  to   1877 101 

Schafer,  Dr.  G.   R.,  Morton 411 

Schackford,   Dr.   B.   S.,   Decatur 258 

Schermerhorn,  Dr Ottawa 39 

Schmidt,    Dr.    Louis,    Chicago 272,  299 

Schoolcraft 21,     22,   31 

Schoolfield,   Dr Joliet 39 

Schussler,  Dr.  \V.   R..  Orland 411 

Scott;   General    troops   enroute    to   Black    Hawk   War 102 

Scott,    Dr.    John    W.,    Springfield 156,    162,    365,  411 

Shattuck,   Dr.   Lemuel,    (Mass.) 131 

Shawneetown,    survey   of   prior   to    1877 118 

Sheppard-Towner    Act - 200,  23S 

Schoemaker,   Dr.   S.   H.,   Monroe  County 85 

Silver  nitrate,   distribution   of   vaccine 218 

Singleton,    Dr (Va.) 63 

Skoog,   Paul    (Calif.) 243 

Sloan,  Dr.  E.  P.,  Bloomington 196,   197,  203 

Small,  Governor   Len,  Kankakee 4.   7 

Smallpox.  .9,  21,  22,  24,  25,  26,  33,  39,  7S,  105,  136,  141.  167,  194,  253,  306,  353,  363,  366,  401 

and    vaccination 307 

annual   death  rates   in  Chicago Ill 

cases    of 309 

deaths   from    49,   50.   61 

disease  of  Indians 49 

free  vaccination  against 49,   156,   248,   250,   307,  401 

of   scliool   children   required 148 

vaccine    for,    distributed 219 

general    epidemics    of 156 

history  of  epidemics  in  Chicago,  article 313 

investigation  of  every  reported  case  of 202,  312 

pay   for   field    work   undecided 161 

prohibiting  transportation  of  bodies  dead  from 150 

troops    immunized   against 182,    188,  311 

Smart,   Dr.   Charles on    typhoid   fever 79 

Smejkal,    Dr.   Edward   J..   Chicago 164,  265 

Smith,    Dr .lacksonville 3S 

Smith,    Dr.    C.    K.,    Decatur 25S 

Smith,    Prof.    George    W.,    Carbondale 34 

Smith,  Dr.  Harold,  Chicago,  committee  on  child  hygiene 242 

Smith,  Dr.  Nathan on  unity  of  fevers 73 

Smith,    Dr.    Stejihen,     (New     Yi.rk) 105 

Smith,   Dr.   W.    R..   Cairo 332 

Snakebite     47,  401 

Snuck,   Dr Darwin 39 

Social   hygiene,  see  venereal  disease 

Sorgatz,   Dr.   George  K 254 


437 


Spalding:,   Dr Oalesburg 64 

Spalding,    Dr.    Heman.    ("hicago 315 

Spanish    fever    (dengue) 46 

Spanish    Influenee.    The 27 

expedition     14 

Spindel.    Dr.   Enos   S.,   Springfield 411 

Springfield,  survey  of  prior  to  1877 lln 

Stahl,  Dr.  Daniel,  Quincy 4!.    Sfi 

Starkel,    Dr.    C.    H.,    Belleville 411 

Standard    railway    sanitary    code 226 

State  Board  of  Health,  future  of 407 

machinery     1.33,  136 

members  of 124,    137.  411 

organized    127.    137,  404 

presidents   of 146,    155,    175,  411 

secretaries   of 140,    162,  411 

State  water  survey,   Urbana,    to   make   investigations 170,    173.    221,  246 

Statistics,    see    mortality,    vital    statistics,    Chicago    statistics 

Stearate   of  Zinc    toilet    powder 205,  214 

Stermont,  Dr.  D.  W.,    279 

Stevenson.  Dr.   Sarah  Hackett.   Chicago 411 

Stewart,    Dr.    J.    T.,    Peoria 85 

St.    Martin.   Alexis 23 

Strothers    (1729)    on    typhoid    fever 71,   72 

Summary  and  conclusion :196-411 

Summer     complaint 86 

Sullivan.  Dr.  J.  C,  Cairo 411 

Survey  of  certain  Illinois  cities,   prior  to  1S77 101-119 

fifteen  cities  in  Illinois 19S 

State  sanitary 147,   1S7,    243.   322.    370.  374 

Sydenham    (1661)    on   typhoid   fever 71.   72 

Syphilis 17,  21,  22.   24.   252,  256,  270,  298 

origin     of 58 

Synechia     (malaria) 78 

Szwajkart,   Dr.   Adam,    Chicago 411 

— T — 

Tanner,    (iovernor    .John    K.,    .Springfield 284 

Tanner,  Dr.  P.  W.,  Urbana 258 

Taylor,   Dr.  G.   G.,   Chicago 268 

Taylor,   Dr.    L.   C.    Springfield C3.    247,  261 

Ten   Bi-ook,    Dr.    John 270 

Tetanus    infections 65,    168,  244 

Texas    tick    fever 105 

Thilo,    Dr.    George,   Oak   Park 249,  411 

Thompson,   Dr.   Samuel,   Edwards  County 40,    52.   84 

Thornhill.  Verna   (Washington.  D.  C.)  on  dental  hygiene 242 

Thwaite 32 

Tillson : 31,   35 

Todd.    Dr ,    Springfield 38 

Tornado  zone,  relief  work  in ' 243.   260,  263 

Trachoma     surveys 289 

Traders    22 

Trappers 13,    22.   24 

Treacy.  F.  A 210 

Trembles,     Indian 67 

Tuberculosis 17,  20,  36,  60.  168,  244,  252,  294 

annual   death   rates  in  Chicago Ill 

cases   of,   table   on 363 

mortality     from 89,362 

graph    on 362 

in    White    County,    map    on 371,  372 


428  INDKX 

PAGE 

Tuberculosis — Conoluded. 

phenomenal   progress   in   ei'MdiiMtion   of 30fi 

sanatoria,  establisliment  of 163,    172,   17it,    220,   2S9,    2;n,   365,   368,   373 

Tuberculin   testing  of  herds 163,   202,   301,   369,   374 

Typhoid   fever 

!),   IS,  20,  21,  31,  33,  35,  40,   44,  47,  69,   90,   US,   136,   16S,   244,   252,   304,   366,   383,    400 

and    malaria 69-83 

attributed    to   contaminated   oysters 204 

carriers    214 

cases  -and    deaths    from 338,   340,   347 

epidemics  of 69-83,   341 

milk-borne    and    water-borne 345 

food   poisoning  as  a  source   of  confusion 81 

graph    on 342 

history  of  steps  in  establishment  of  as  a  specific  disease 70 

investigation   every   reported   case   of 202 

phenomenal    progress    in    eradication    of 306,   338 

prevalence  of  after   1S50 82 

rules  and  regulations  for  control  of 150 

troops    immunized    against 182,   188 

vaccine    distributed 217 

see  Chicago  statistics 

Typhus  fever 17,  33,   35,   73,  74,   75.   78,   84,   257,   400 

in    Illinois 47 

mortality    in    Chicago 104 

— U— 

ITnited   States  Public  Health   Service.   JIarine  Hospital   Service  created 172 

University  of  Illinois,  appropriations  to  equip  and  maintain  water  laboratory  at...    246 

State  Water  Survey  to  make  investigations  water  supplies 170,   173,   221,   246 

vaccine   farm    established   at 157,    249,   311 

Utesch,    John    W.,    Chicago 265 

— V — 

Vaccination   against    smallpox 49,    156,    307,   401 

history  of  epidemics  of  smallpox  in  Chicago,  arliile 313 

required   of   school   children 148 

Vaccines,  distribution  of 148,  1S2,   18S,  218,  248,  250.  356,  389,   401 

farm   established   for  propagation    of 157,    249,   311 

Vandalia,  survey  of  prior  to   1877 118 

removal   of  capital   from 115 

Vaughan,   Dr.   Victor  C,    (Mich.) 42,   79 

Veatch,    Dr.    W.    P.,    Roodhouse 79,85 

Venereal  di.sease 17,  21,  22,  24,  58,  60,  186,  253,  257,  262,  268,  298,  306,   408 

chart    on 272 

establishment    of    clinics 271 

Vincent,   Dr.   John  A.,    Springfield 155,411 

Vital   statistics  and  mortality   rates,   all    causes 96,   173,   186 

collection  of 130,   135,   141,   159,   193,   200,   230 

decennial    census    reports 397 

in  Chicago 50,  51,  83,  87,  89,  90,  99,   102.   107-114,  313,  320,   397 

Vollmer,    Di-.    Maude,    Moline 258 

Voluntary   health  agencies 14.    171.    191,    220,    287-303 

— w — 


129,    130,    137,    146,    411 

125 

339 


Waiclu.-r.    Dr.    lloiacc,   Cairo l^-», 

biography    of 

Wai-e,  Dr.  John  S.,  Chicago,  on  typhoid   fever 

Washington,  George,  death  of  from  cynanche 56 

Water   supplie.s,   investigations   of 17,    151,    170,    244,    245,  343 

Weber,    Prof.    H.    A.,    Ui-bana 245 

Webster,  Dr.  Geoi-ge  W.,  Chicago 169,   175,  411 

Webster,    Noah    (1799)    on    pestilential    diseases "'^ 

Welles     (lf.S2l     on     lyi>li..id     lever 71,72 


429 


Wells,    Dr.    Wiiltei-    A.,    (Washington,    D.    C.) 56 

Wentwortli,   John,  Chicago 101 

Wenzel,    Dr.    F.,    Belleville 41 

We.s.sel,    Dr.    P.    H.,    Moline 41! 

Whistler,    Dr Chicago 102 

Whitehead,    Dr LaSalle 3SI 

Whitmore,    Dr.    J.    S.,    Metamora 53 

Whooping-  cough 25,   33,   252,   366,   374,   330,  402 

annual    death    rates    in    Chicago 112 

cases     of 3!)1 

mortality    and    rates 331 

graph     on 332 

Wightman,    Dr.    tJrace    S.,    Chicago 235 

Wilkins,    Colonel (1768) 26 

Will,    Dr.    Conrad,    Jackson    County 130 

Williams,   Di-.  Daniel   H.,   Chicago 153,  411 

Williamson,    Dr.    T.    S.,    (Ohio) 21 

Winter,  S.  G.,  Galesburg 25S 

Wolcott,    Dr.   Alexander n    malignant    fevers 102 

Woodward,    Dr.    J.    J.,    (Washington,    D.    C.) 79.   84 

World    war    activities 182,   186,  373 

.social    hygiene   a   problem 1S6 

troops  immunized  against   typhoid  fever  and  smallpox 182,    188,   311 

Worrell,  Dr.  T.  F.,  debate  on  cholera 45 


Worthington,    Mrs.    Sarah    M.,    Sterling. 

Wright,    Dr Warren    County. 

Wi-ight,    Dr.    John,    Clinton 


— y — 

Yates,    Governor    Richard.    Jacksonville 167 

Yellow  fever 3,   46,   72,   73,    136.    157,   168.   244,   353,   363,  400 

appropriation     for 143,  333 

epidemics    of , 46 

inspectors  at  Caii-o,  cut  of 337 

map    of    Cairo 330 

outbreak   of  at   Cairo 32.    141,    172,    212.    327,  33S 

prohibiting  transpoi-tation  of  bodies  dead  from 150 

rules  and   regulations   for   control    of 150 

Young,    Dr.    D.    W.,    Aurora S7 

debate    on    cholera 45 

— Z — 

Zeit,    Dr.    F.    Robert.   Chicago 245 

Zeuch.  Dr.  Lucius  H..  Chicago 15,  24,  26,  27,  32,  42,  44,  50,  53,  54,  55,  57,  68,  84,  SS,  278 


AUXILIARY  HEALTH  AGENCIES. 

PAGE 

Aiiu-lican   Cliild      lU-;illli     Association 287 

American   Dental     Association 288 

Aesculapian   Society  of   Wabash  Valley 74.   130,   279,  404 

American  Medical   Association 262,397 

American  Public  Health  Association 130,    131,   171,  287 

American  Red    Cross 297,  373 

American   Society    for   Control    of    Cancer 298 

Carnegie     Foundation 251 

Chicago  Dental     Society 200,243 

Chicago  Heart  Association 296 

Chicago  Infant    Welfare    Society 301 

Chicago  League  for  Hard  of  Hearing 296 

Chicago  Medical    Society 40,    103,    2SS,    301,   366.  405 

Chicago  Tuberculosis  Institute 290,   36S,  405 

I  'liiklren's  Bureau     287 

Cliildren's  Hospital    and    Milk    Commission 300 

Conference    of    State    and    Provincial    Health    Authorities 171 

Illinois  Council    Parent-Teacher    Associations 200,  242 

Illinois  Dental     Society 200,   240.  242 

Illinois  Federation  of  Women's  Clubs 200,   201,  240,  242,   2SS,  289 

Illinois  Health     Society 303 

Illinois  Medical   Society,  Transactions 30,   44,   47,   54.   55,   57,    63,   65, 

69,   74,   76,   SI,   85,   87,    130,    159,   200,   240,    242,  279,   280,   283,   287.   2SS,   2S9.   293,   397,  404 

Illinois  Social    Hygiene    League 298 

Illinois   Society  for  Crippled  Children 235,  380 

Illinois  Society    for    Mental    Hygiene 297 

Illinois  Society  for  Prevention  of  Blindness 289 

Illinois  Tuberculosis  and  Health  Association 220,  293.   303,  373 

Industrial   and    practicing  physicians 297 

International   Health    Board 287 

Jersey  County  Medical  Society 130,   132,  280 

Laboratories    and    Universities 296 

Tjawrenceville  Aesculapian  Society 130,  397 

Elizabeth  McCormick  Memorial  Foundation ^ 302 

National   Board   of  Health 139,  143 

National   Educational*  Association 287 

National   Health    Board 383 

National   Safety    Council 295 

National   Tuberculosis    As.sociation 287 

Parent-Teacher    Associations 295 

State  and   local   dental   societies 296 

State  Board    of   Health   Auxiliary    Sanitary    Association 245,   247,  249 

State  Health    Society 296 

United    States    Public    Health    Service 204,    270,    287,  299 

Visiting    Nurse    Association 290,   291,  366 

REFERENCES  AND  BIBLIOGRAPHY. 

A   Doctor's   Memories,    Vaughan 42 

Adventures   of   BMrst    Settlers,    Boggess IS,   59,  381 

A  Journey  up   the   Illinois  River,   Schoolcraft 31 

American   Medical    Association    Journal,    Hrdlicka 58 

American  Journal    of    Hygiene,    Atwater 50 

American  Journal    of    Medical    Sciences 65,   73,   78,  397 

American  Medical    .lourn.il 65 

American  Notes      32 

Annals    of   Health    and    .Sanitation.    Kochler 102 

(430) 


EEFEREXCES    AND   BIDI.IOGRAPHY  431 

PAGE 

Army   Statistical    Reports t>4 

Bloomington     Intelligencer 45 

British   Research  Council,   Savage  and  White SI 

Bulletin   Society  Medical  History  of  Chicago,   1912 105 

Buffalo   Medical    Journal,   Flint 7S 

Bureau  of  Ethnology,  Bulletins  30,  34,  Hrdlicka 17,   IS,   19,   20,   49,   53,   55,   5S,    60 

Cairo     Bulletin 46 

Centennial    Survey   of   the   State   of   Public    Hygiene   in    Ameri<-a 244 

Chicago  and    the    Old    North    West,    Quaife 102 

Chicago  Health  Department  Report 43,   49,   50,   54,   56,   S7 

Chicago  Inter-Ocean    280 

Chicago  Bledical    Examiner,    Veatch 79 

Classical  Work  on  Fevers,  Bartlett 43 

Committee  on  Practical  Medicine ....  40.  44.  46,  47,  52,  57,  61.  63,  66,  67,  70.  76,  S4,  83,   ,S6 

Continued    Fevers,    Murchison 71 

Epidemiology  and  Public   Health,   Vaughan 79 

Egyptian    Republican 45,   50 

Handbook  of  Geographic  and  Historical  Pathology,   Hirsch 43,   50,  55,   56,  63,   71 

Health  News   (State  Medicine)    (Bulletin) 169,   177,    192,    266,   267 

Historic  Illinois,   Parrish 44,    53 

History  of  Alabama,  Pickett 13 

History  of  Continued   Fevers,    Bartlett 73,   77 

History  of  Illinois  and   Her   People,    Smith 34 

History  of   Indian   Tribes  of  United   States,    1857,   Schoolcraft 22 

History  of  jNIorgan    County,    Short 45 

History  of  Practice   of  Medicine,    Zeuch 

15,   24,   26,   32,   42,   44,   50,   53,   54,   55,   57,  ^68,   84,   88,   278 

mini,   A   Story   of   the   Prairies,    Carr 43 

Illinois  &   Indiana   Medical   &    Surgical    Journal 52,    75,    78,   279 

Illinois  as  It  Is,   Gerhard 61 

Illinois  Historical    Collection,    Alvord    Carter 26 

Illinois  Historical    Library    Publications 31.     43,    118 

Lectures  on  the  Principles  and  Practice  of  Medicine,   Davis 338 

Life   of   Lincoln,    Sanburg 36 

London     Lancet 78,    153 

Lyon  Medical,  1912,  Gandolphe 59 

Medical  and  Surgical  History  of  the  War  of  the  Rebellion,   Smart ...79,   84 

Medical   Repository  of  Original  Essays 63 

Military   Surgeon      ■ 64 

Military   Tract   Medical    Society,    Kgan 78 

Monmouth    Atlas 46 

Morgan's    Journal 26 

My   Own    Times,    Reynolds 32 

New  Orleans  Medical  &  Surgical   Journal 58 

New  York   Journal    of    Medicine 64 

New  York   Medical   Board 339 

New   York   Medical   Journal  and   Record 19,   70 

New   Y'ork  Medical  &   Surgical   Journal 58 

North    American    Indians,    Catlin '. 49 

Northwestern  Medical  &   Surgical   Journal 74 

Philadelphia  Medical  &  Surgical   Reports 57 

Pictures  of   Illinois,   100   years  ago 118 

Pioneer  Health   Conditions 36 

Pioneer  History   of   Illinois,    Reynolds 67 

Pioneer  Mothers    in    Illinois,    Worthington 31 

Practice   of    Medicine,   Anders 76 

Practical    Treatise   on    Enteric    Fever 70 

Reminiscences    of   a    Pioneer   Woman,    Tillson 31,   35 

Report  on  Practical  Medicine 40.  44.  46.  47,  52,   57,   61,  63,   66,  69,  70,  76,  84,  S5,   86 

Sanitarian     (1880) 339 

Sanitary    History    of    Chicago,    Hauch 102 

Sanitary    Investigations   of   the    Illinois   River  and    Tributaries 222 


132  RICrKklCNCKS    A-NU    UUILIOCUAPII V 

PACK 

Settk-nuMit    of    mine. is.    The SO 

Sixty   Years   in    Medical    Hainess,    Johnson 42.    55.    SO,   82 

Springrfleld    Journal    (1852) 45 

St.    Louis   Medical    and'  Surgical   Journal    (1849) 40.   S5 

Systematic  Treatise  on  Diseases  of  the  Interior  Valley  of  North  America,  Hiake.... 

" 3S.    47.    49.    52,    53,    54.    60,   64,   84 

Transactions,  American  Medical  Association 75.   78,   79 

Transaction.s.  lIliM.iis  .Medical  Society ...  39.  44,  47.  54.  55,  57,  63,  65,  67,  74,  76,  81.  85.   87 
Western  iMedical  and  Physicians  Journal 39,   52,  63.  64,  70.  73.  76,  86.   397 


LJ 


THE  RISE  AND  FALL  OF  DIs'MluiNOIS 


3  0112  025313070 


